Provider Demographics
NPI:1093533226
Name:NANAN CHIRAKKAL, JILDA FATHIMA
Entity type:Individual
Prefix:
First Name:JILDA FATHIMA
Middle Name:
Last Name:NANAN CHIRAKKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 SE 174TH ST APT 3440
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5869
Mailing Address - Country:US
Mailing Address - Phone:425-533-4558
Mailing Address - Fax:
Practice Address - Street 1:1501 39TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3801
Practice Address - Country:US
Practice Address - Phone:253-841-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP612519722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant