Individual
KATHLEEN CLANCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
6611 159TH AVE NE, REDMOND, WA 98052-4813
(425) 326-8383
Mailing address
PO BOX 202, REDMOND, WA 98073-0202
(425) 326-8383
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL 60575085
STATE CREDENTIAL
WA
01
—
SP 15963
STATE LICENSE
CA
Enumeration date
05/26/2015
Last updated
03/11/2016
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