Individual provider Active NPI

Kali Elizabeth Glynn, SPEECH THERAPIST

  • Speech-Language Pathologist
  • Mill Creek, WA
National Provider Identifier
1407169410
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
LL00004438 Issued in WA
Practice address
16030 Bothell Everett Hwy Ste 140
Mill Creek, WA 98012-1273
Phone
(425) 338-9005
Fax
(425) 337-0931
NPI assigned
Jul 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X LL00004438 WA Primary

Addresses

Primary practice location

16030 Bothell Everett Hwy Ste 140
Mill Creek, WA 98012-1273

Mailing address

16030 Bothell Everett Hwy Ste 140
Mill Creek, WA 98012-1273
Phone (425) 338-9005

Other practice location 1

18504 Bothell Way NE
Bothell, WA 98011-1927
Phone (425) 481-1933

Other names 1

  • Kali Elizabeth White Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220329002188 WA Practitioner - Qualified Speech Language Pathologist 7719373836 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LL00004438WAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehabilitation Group, PC CurrentSince Jan 24, 2022 Accepting new patients
Integrated Rehabilitation Group, PC CurrentSince Jan 24, 2022 Accepting new patients

Locations

10207 19th Ave SE
Everett, WA 98208
Phone (425) 337-3166

403 W Stanley St
Granite Falls, WA 98252
Phone (360) 691-4835

16030 Bothell Hwy
Ste 140
Mill Creek, WA 98012
Phone (425) 338-9005

4220 132nd St SE
Ste 101
Mill Creek, WA 98012
Phone (425) 316-8046

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1407169410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 140",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-338-9005",
            "fax_number": "425-337-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 140",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-338-9005",
            "fax_number": "425-337-0931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18504 Bothell Way NE",
            "address_purpose": "LOCATION",
            "city": "Bothell",
            "state": "WA",
            "postal_code": "980111927",
            "country_code": "US",
            "telephone_number": "425-481-1933",
            "fax_number": "425-481-1933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "KALI",
        "middle_name": "ELIZABETH",
        "credential": "SPEECH THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00004438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALI",
            "last_name": "WHITE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.