MEDICARE: NORTHWEST VESTIBULAR SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist	CD00001153	WA
2	231HA2500X	Assistive Technology Supplier Audiologist	CD00001153	WA
3	231H00000X	Audiologist	CD00001153	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0209957	OTHER	WA	L&I

General Provider Information

NPI Number	:	1174657464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST VESTIBULAR SERVICES, PLLC

Provider Business Mailing Address
First Line	:	418 1ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-4018
Country	:	US
Telephone Number	:	206-325-0645
Fax Number	:	206-283-9815

Provider Business Practice Location Address
First Line	:	418 1ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-4018
Country	:	US
Telephone Number	:	206-325-0645
Fax Number	:	206-283-9815

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL KILLINGSWORTH
Credential	:	AUD
Telephone Number	:	206-325-0645

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	02/21/2011

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