Provider Demographics
NPI:1396135042
Name:MOSIAC CHILDREN'S THERAPY CLINIC
Entity type:Organization
Organization Name:MOSIAC CHILDREN'S THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, BSCED
Authorized Official - Phone:425-644-6325
Mailing Address - Street 1:13010 NE 20TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2054
Mailing Address - Country:US
Mailing Address - Phone:425-644-6325
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2054
Practice Address - Country:US
Practice Address - Phone:425-644-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health