Provider Demographics
NPI:1720741341
Name:IRVINE, MARIA FA'ANUNU (SLPA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FA'ANUNU
Last Name:IRVINE
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 1:25 HORSE SPRING COULEE RD
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-9738
Mailing Address - Country:US
Mailing Address - Phone:208-240-2889
Mailing Address - Fax:
Practice Address - Street 1:35 STATE HWY 20
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9601
Practice Address - Country:US
Practice Address - Phone:208-240-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612078122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant