Individual
NICOLE A BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 251-5165
Mailing address
3600 LIND AVE SW, SUITE 100 - CREDENTIALING, RENTON, WA 98057-4970
(425) 228-3440
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60815606
WA
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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