Individual
SHELLY GRACE LOZANO MARIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
12036 64TH AVE S, SEATTLE, WA 98178-3603
(206) 785-5898
Mailing address
12036 64TH AVE S, SEATTLE, WA 98178-3603
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
235Z00000X
Speech-Language Pathologist
Primary
61206262
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111524501
—
WA
Enumeration date
12/27/2017
Last updated
02/26/2023
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