Jaclyn Liana Colburn, MS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Snoqualmie, WA
NPI 1467836635 · NPPES record last updated Feb 9, 2024
Key facts
- NPI
- 1467836635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- PENDING (WA)
- Practice address
- 9050 385TH Ave SE
Snoqualmie, WA 98065 - Phone
- (425) 888-3347
- NPI assigned
- Jul 16, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240307000735 | WA | Practitioner - Qualified Speech Language Pathologist | 9739525288 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | WA | MD | Dentist |
| 3206 | CA | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District No 4 King County Washington | Current | Accepting new patients | |
| MMG Speech & Therapeutic Services, LLC | Speech-Language Pathologist | Past |
Accepting new patients |
Locations
9801 Frontier Ave SE
Snoqualmie, WA 98065
Phone (425) 831-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 3206 | CA | |
| Speech-Language Pathologist | 235Z00000X | PENDING | WA | Yes |
Addresses
Primary practice location
9050 385TH Ave SE
Snoqualmie, WA 98065
Mailing address
6768 E Leafwood Dr
Anaheim, CA 92807-5028
Other practice location 1
38243 SE 85th St
Snoqualmie, WA 98065-9608
Phone (714) 394-7325
Other providers in Snoqualmie, WA
- Alan Richard Chock
- Carlene Chung
- Camille Rae Cirhan
- City of Snoqualmie
- Coalesce Wa PLLC
- Colleen T Peck MD PLLC
- Theresa Jean Colonna
- Colyn Nouv, DPM PLLC
- Colyn Nouv, DPM PLLC
- Lisa Connors
All providers in Snoqualmie, WA · Speech-Language Pathologist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.