Individual
KAILEY MARIE FALCON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 3RD AVE, LONGVIEW, WA 98632-3231
(360) 425-9810
Mailing address
1600 3RD AVE, LONGVIEW, WA 98632-3231
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015775
OR
235Z00000X
Speech-Language Pathologist
SLP.LL.60770092
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497809636
—
WA
Enumeration date
06/20/2017
Last updated
06/20/2017
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