Traci Marken San Juan, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

61090211 Issued in WA

Practice address

3400 Hollywood Ave
Bellingham, WA 98225-1134

Phone

(541) 306-8097

NPI assigned

Sep 8, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1699444158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2018 WHATCOM LN",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982292238",
            "telephone_number": "541-306-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 HOLLYWOOD AVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251134",
            "telephone_number": "541-306-8097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN JUAN",
        "first_name": "TRACI",
        "middle_name": "MARKEN",
        "name_prefix": "Mrs.",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "61090211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Varinder Samra, RPH
• Jay Bradley Samson, LMHC
• Jodi L Samson, LMT
• Allison Samuel, RN, CCM
• Elisabeth Samuel, LMP
• Emelie Sanabria, CPDT
• Janna Sanabria, LMP
• Janelly Alexandra Sanchez
• Haley E Sandberg, DC
• William Scott Sandeno, M.D.

• Speech-Language Pathologist in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.