Basic Information
| Provider Information | |||||||||
| NPI: | 1023624822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSETTE | ||||||||
| FirstName: | KATHRIN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10304 INTERLAKE AVE N | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981339414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258907462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 S STEEN RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990378030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556333627 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2020 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL60316940 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.