Provider Demographics
NPI:1487546701
Name:SILVA MILLAN, KENNETH JESUS
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JESUS
Last Name:SILVA MILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W CASINO RD APT B102
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1766
Mailing Address - Country:US
Mailing Address - Phone:541-709-7753
Mailing Address - Fax:
Practice Address - Street 1:1604 HEWITT AVE STE 301
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3536
Practice Address - Country:US
Practice Address - Phone:425-405-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.70007678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist