Provider Demographics
NPI:1104225218
Name:MCKIM THOMAS, SARAH SUMMER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SUMMER
Last Name:MCKIM THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16720 REDMOND WAY STE G
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4484
Mailing Address - Country:US
Mailing Address - Phone:206-486-2906
Mailing Address - Fax:509-821-9219
Practice Address - Street 1:16720 REDMOND WAY STE G
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4484
Practice Address - Country:US
Practice Address - Phone:206-486-2906
Practice Address - Fax:509-821-9219
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60487418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136947Medicaid