MEDICARE: MR. JOSEPH RAAP M.A

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	231H00000X	Audiologist	LD00001396	WA

General Provider Information

NPI Number	:	1558342758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH RAAP M.A

Provider Business Mailing Address
First Line	:	605 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2007
Country	:	US
Telephone Number	:	360-833-0609
Fax Number	:	360-833-0622

Provider Business Practice Location Address
First Line	:	605 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2007
Country	:	US
Telephone Number	:	360-833-0609
Fax Number	:	360-833-0622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	10/17/2011

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