Basic Information
| Provider Information | |||||||||
| NPI: | 1093157935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNDZIUS | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A., CCC-SLP/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1337B 14TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981443409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146886270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13010 NE 20TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980052034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256446328 | ||||||||
| FaxNumber: | 4256446295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL60390523 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SL011128 | PA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.