Provider Demographics
NPI:1073857926
Name:MORTENSEN, JANNA MICHELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:MICHELLE
Last Name:MORTENSEN
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 1:14321 SE 6TH ST APT M207
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7057
Mailing Address - Country:US
Mailing Address - Phone:949-735-4275
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2054
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60391663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist