Provider Demographics
NPI:1104928761
Name:MCLAUGHLIN, IRNA REYES (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:IRNA
Middle Name:REYES
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27242 CHURCH CREEK LOOP NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7448
Mailing Address - Country:US
Mailing Address - Phone:425-530-1385
Mailing Address - Fax:360-629-3432
Practice Address - Street 1:27242 CHURCH CREEK LOOP NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7448
Practice Address - Country:US
Practice Address - Phone:425-530-1385
Practice Address - Fax:360-629-3432
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL00003007OtherSTATE LICENSE
WA09141193OtherASHA NATIONAL LICENSE
WA7132095Medicaid