Provider Demographics
NPI:1871148577
Name:EBACHER, MIESHA JO (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIESHA
Middle Name:JO
Last Name:EBACHER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-6301
Mailing Address - Country:US
Mailing Address - Phone:360-608-3632
Mailing Address - Fax:
Practice Address - Street 1:17912 NE 159TH ST
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9613
Practice Address - Country:US
Practice Address - Phone:360-448-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist