NPIMap

Organization Active NPI

Wonderland Developmental Center

  • Speech-Language Pathologist
  • Shoreline, WA
National Provider Identifier
1982779948
Registry record updated Oct 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
LL00003297 Issued in WA
Legal business name
WONDERLAND DEVELOPMENTAL CENTER
Practice address
816 N E 190TH St
Shoreline, WA 98155
Phone
(206) 364-3777
Fax
(206) 364-3999
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2013

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

Authorized official

Name
Ms. Mary L. Kirchoff
Title
Executive Director
Phone
(206) 364-3777

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X LW 00004438 WA
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT00000540 WA
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT60282093 WA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X LL00003297 WA Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SI 60251616 WA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X LL 00004312 WA

Addresses

Primary practice location

816 N E 190TH St
Shoreline, WA 98155

Mailing address

PO Box 55399
Shoreline, WA 98155
Phone (206) 364-3777

Other identifiers 2

IdentifierTypeStateIssuer
7682651MedicaidWA
7300965MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Hope Rising Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

816 N E 190TH St
Shoreline, WA 98155
Phone (206) 364-3777

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382400000000",
    "number": "1982779948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55399",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98155",
            "telephone_number": "206-364-3777",
            "fax_number": "206-364-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 N E 190TH ST",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98155",
            "telephone_number": "206-364-3777",
            "fax_number": "206-364-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDERLAND DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-10-22",
        "status": "A",
        "authorized_official_last_name": "KIRCHOFF",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-364-3777",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW 00004438",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00000540",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT60282093",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00003297",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "SI 60251616",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL 00004312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7682651",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7300965",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; 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.