Provider Demographics
NPI:1104926120
Name:MAKI, ELAINE TINA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:TINA
Last Name:MAKI
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 1:1115 SUDDEN VLY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4829
Mailing Address - Country:US
Mailing Address - Phone:360-201-1689
Mailing Address - Fax:360-312-4362
Practice Address - Street 1:1400 KING ST
Practice Address - Street 2:SUITE B104
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6262
Practice Address - Country:US
Practice Address - Phone:360-201-1689
Practice Address - Fax:360-312-4362
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7967MAOtherREGENCE BLUESHIELD
WA7133713Medicaid
WA09128OtherFIRST CHOICE HEALTH