Abigail Desjardien, M.a. CCC-SLP, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ABIGAIL DESJARDIEN, M.A. CCC-SLP, LLC

Practice address

18208 66TH Ave NE Ste 200
Kenmore, WA 98028-7949

Phone

(425) 419-6199

Fax

(855) 891-8297

NPI assigned

Oct 9, 2018

Organization subpart

No

Name

Abigail Desjardien, M.A. CCC-SLP

Title

Speech Language Pathologist

Phone

(425) 419-6199

• Northshore Pediatric Speech and Language Therapy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 9, 2018.

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539043200000",
    "number": "1750856415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19207 63RD AVE NE",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980283329",
            "telephone_number": "360-920-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18208 66TH AVE NE STE 200",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980287949",
            "telephone_number": "425-419-6199",
            "fax_number": "855-891-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABIGAIL DESJARDIEN, M.A. CCC-SLP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A",
        "authorized_official_last_name": "DESJARDIEN",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "425-419-6199",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60051932",
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northshore Pediatric Speech and Language Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northshore Pediatric Speech and Language Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Kenmore, WA
• Multi-Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.