Provider Demographics
NPI:1124163985
Name:SHATTO, MEREDITH (SLP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:SHATTO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 E MARGINAL WAY S STE B100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2322
Mailing Address - Country:US
Mailing Address - Phone:206-763-0352
Mailing Address - Fax:206-762-0111
Practice Address - Street 1:4636 E MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2382
Practice Address - Country:US
Practice Address - Phone:206-763-0352
Practice Address - Fax:206-762-0111
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA7018518Medicaid