Basic Information
| Provider Information | |||||||||
| NPI: | 1528043015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEELY-FADICH | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | C | ||||||||
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| OtherLastName: | SEELY | ||||||||
| OtherFirstName: | AIMEE | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 350 | ||||||||
| Address2: | |||||||||
| City: | MAPLE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980380350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253580956 | ||||||||
| FaxNumber: | 8774816931 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 N EMERSON AVE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988016619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096632157 | ||||||||
| FaxNumber: | 5096637272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | LD00002103 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1044574 | 05 | WA | MEDICAID |