Provider Demographics
NPI:1285382267
Name:CARDENAS, ADRIANA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:CARDENAS
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:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:MABTON
Mailing Address - State:WA
Mailing Address - Zip Code:98935-1032
Mailing Address - Country:US
Mailing Address - Phone:509-643-1025
Mailing Address - Fax:
Practice Address - Street 1:404 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1201
Practice Address - Country:US
Practice Address - Phone:509-787-8992
Practice Address - Fax:509-787-8995
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61366850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist