Provider Demographics
NPI:1154967917
Name:RAM, POORNIMA
Entity type:Individual
Prefix:MRS
First Name:POORNIMA
Middle Name:
Last Name:RAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 229TH PL NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2067
Mailing Address - Country:US
Mailing Address - Phone:425-977-3891
Mailing Address - Fax:
Practice Address - Street 1:9043 229TH PL NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2067
Practice Address - Country:US
Practice Address - Phone:425-977-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60982472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist