Provider Demographics
NPI:1124882386
Name:ELLIOTT BAY SPEECH PATHOLOGY
Entity type:Organization
Organization Name:ELLIOTT BAY SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:KATHRYN BELFIT
Authorized Official - Last Name:GOPALAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-877-2643
Mailing Address - Street 1:3050 MAGNOLIA BLVD W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2413
Mailing Address - Country:US
Mailing Address - Phone:503-877-2643
Mailing Address - Fax:
Practice Address - Street 1:3050 MAGNOLIA BLVD W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-2413
Practice Address - Country:US
Practice Address - Phone:503-877-2643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech