Provider Demographics
NPI:1073273793
Name:SON, JEEWON KELLY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEEWON
Middle Name:KELLY
Last Name:SON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 HANNA DR NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-7169
Mailing Address - Country:US
Mailing Address - Phone:562-544-8032
Mailing Address - Fax:
Practice Address - Street 1:3119 HANNA DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-7169
Practice Address - Country:US
Practice Address - Phone:562-544-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61141790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61141790OtherCCC-SLP