Individual
MR. KALYAN NAGALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SPEECH THERAPIST
Contact information
Practice address
516 176TH ST E, SPANAWAY, WA 98387-8335
(253) 683-6924
Mailing address
3037 S 154TH ST, APT: A108, SEATAC, WA 98188-2145
(206) 257-9251
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
426607H
WASHINGTON STATE EDUCATION CERTIFICATE INITIAL ESA
WA
01
—
LL60265399
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
10/29/2012
Last updated
11/01/2012
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