Provider Demographics
NPI:1780917062
Name:HARBOR SPEECH PATHOLOGY, PS
Entity type:Organization
Organization Name:HARBOR SPEECH PATHOLOGY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGISYT
Authorized Official - Prefix:
Authorized Official - First Name:CHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-851-0007
Mailing Address - Street 1:5202 OLYMPIC DR NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1727
Mailing Address - Country:US
Mailing Address - Phone:253-851-0007
Mailing Address - Fax:253-514-8261
Practice Address - Street 1:5202 OLYMPIC DR NW
Practice Address - Street 2:SUITE 100
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1727
Practice Address - Country:US
Practice Address - Phone:253-851-0007
Practice Address - Fax:253-514-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003975225X00000X
WA602840742261QH0700X
WALL00003090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty