Organization
WONDERLAND DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY L. KIRCHOFF (EXECUTIVE DIRECTOR)
(206) 364-3777
Entity
Organization
Contact information
Practice address
816 N E 190TH ST, SHORELINE, WA 98155
(206) 364-3777
(206) 364-3999
Mailing address
PO BOX 55399, SHORELINE, WA 98155
(206) 364-3777
(206) 364-3999
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LW 00004438
WA
225X00000X
Occupational Therapist
OT00000540
WA
225X00000X
Occupational Therapist
OT60282093
WA
235Z00000X
Speech-Language Pathologist
LL 00004312
WA
235Z00000X
Speech-Language Pathologist
Primary
LL00003297
WA
235Z00000X
Speech-Language Pathologist
SI 60251616
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7300965
—
WA
05
—
7682651
—
WA
Enumeration date
11/22/2006
Last updated
10/22/2013
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