Provider Demographics
NPI:1215487814
Name:STAKELIN, CLAUDINE (SLPA)
Entity type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:
Last Name:STAKELIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-4024
Mailing Address - Country:US
Mailing Address - Phone:360-264-3415
Mailing Address - Fax:
Practice Address - Street 1:301 OLD HIGHWAY 99 SE
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589-9370
Practice Address - Country:US
Practice Address - Phone:360-264-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 602363372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant