Basic Information
| Provider Information | |||||||||
| NPI: | 1245977065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARK-OLIVERO | ||||||||
| FirstName: | LETICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 NE 166TH ST | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981555337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066374658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1919 112TH ST SW | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982043784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255131600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2022 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.