Organization
EDUCATIONAL SERVICE DISTRICT 112
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY SUE KING SP60208742 (SPEECH LANGUAGE PATHOLOGIST ASSISTA)
(360) 560-1030
Entity
Organization
Contact information
Practice address
404 BALCER ST NE, CASTLE ROCK, WA 98611-9647
(360) 560-1030
Mailing address
404 BALCER ST NE, CASTLE ROCK, WA 98611-9647
(360) 560-1030
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
SP 60208742
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SP 60208742
—
WA
Enumeration date
09/17/2012
Last updated
09/17/2012
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