Provider Demographics
NPI:1588978233
Name:SOCIAL SUCCESS LLC
Entity type:Organization
Organization Name:SOCIAL SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP, PART OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:206-371-9133
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 335
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3399
Mailing Address - Country:US
Mailing Address - Phone:206-371-9133
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 335
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3399
Practice Address - Country:US
Practice Address - Phone:206-371-9133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty