NPIMap

Organization Active NPI

Harbor Speech Pathology, PS

  • Speech-Language Pathologist
  • Gig Harbor, WA
National Provider Identifier
1780917062
Registry record updated Jun 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
LL00003090 Issued in WA
Legal business name
HARBOR SPEECH PATHOLOGY, PS
Practice address
5202 Olympic Dr NW
Suite 100
Gig Harbor, WA 98335-1727
Phone
(253) 851-0007
Fax
(253) 514-8261
NPI assigned
Sep 17, 2009
Last updated
Jun 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2017

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

Authorized official

Name
Channa BeckmanNPI 1992909162
Title
Speech Language Pathologisyt
Phone
(253) 851-0007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT00003975 WA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X LL00003090 WA Primary
Hearing and Speech Clinic/Center 261QH0700X 602840742 WA

Addresses

Primary practice location

5202 Olympic Dr NW
Suite 100
Gig Harbor, WA 98335-1727

Mailing address

5202 Olympic Dr NW
Suite 100
Gig Harbor, WA 98335-1727
Phone (253) 851-0007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, FL, CT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100212000226 WA Part B Supplier - Clinic/Group Practice 5395889497 Receives reassigned benefits from 6 practitioners
Practice locations: Gig Harbor, WA; Silverdale, WA
O20230202000601 FL Part B Supplier - Clinic/Group Practice 5395889497 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Walton Beach, FL
O20250604001490 CT Part B Supplier - Clinic/Group Practice 5395889497 Receives reassigned benefits from 2 practitioners
Practice locations: Seymour, CT

National Provider Directory

National Provider Directory

Locations

1555 Post Rd E
Ste 102
Westport, CT 06880

26E Racetrack Rd NW
Ft Walton Bch, FL 32547
Phone (850) 226-6633

5202 Olympic Dr
Ste 100
Gig Harbor, WA 98335
Phone (253) 318-6665

1230 Bay St
#100
Port Orchard, WA 98366
Phone (360) 876-1717

463 Tremont St W
Ste 110
Port Orchard, WA 98366
Phone (253) 855-0007

9576 Ridgetop Blvd NW
Ste L101
Silverdale, WA 98383
Phone (360) 692-7755

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497312000000",
    "number": "1780917062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5202 OLYMPIC DR NW",
            "address_2": "SUITE 100",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351727",
            "telephone_number": "253-851-0007",
            "fax_number": "253-514-8261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5202 OLYMPIC DR NW",
            "address_2": "SUITE 100",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351727",
            "telephone_number": "253-851-0007",
            "fax_number": "253-514-8261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR SPEECH PATHOLOGY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-17",
        "last_updated": "2017-06-13",
        "status": "A",
        "authorized_official_last_name": "BECKMAN",
        "authorized_official_first_name": "CHANNA",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGISYT",
        "authorized_official_telephone_number": "253-851-0007"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00003975",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00003090",
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "WA",
            "license": "602840742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gig Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2017; 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.