Provider Demographics
NPI:1366076549
Name:HENRIQUEZ, JAVIERA P
Entity type:Individual
Prefix:
First Name:JAVIERA
Middle Name:P
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAVIERA
Other - Middle Name:P
Other - Last Name:HENRIQUEZ-VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTHER LAST NAME
Mailing Address - Street 1:23220 113TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3468
Mailing Address - Country:US
Mailing Address - Phone:541-217-1452
Mailing Address - Fax:
Practice Address - Street 1:820 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2207
Practice Address - Country:US
Practice Address - Phone:206-782-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WA61159991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist