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NPI Code Detail

MEDICARE: BALLARD SPEECH & HEARING CTR. P.S.

MEDICARE: BALLARD SPEECH & HEARING CTR. P.S.
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
1291U00000XClinical Medical LaboratoryLD00000978WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11427137447OTHERWAPERSONAL NPI

General Provider Information

NPI Number : 1669637633
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALLARD SPEECH & HEARING CTR. P.S.
Provider Business Mailing Address
First Line : 5428 BARNES AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98107-3839
Country : US
Telephone Number : 206-789-7029
Fax Number : 206-789-5485
Provider Business Practice Location Address
First Line : 5428 BARNES AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98107-3839
Country : US
Telephone Number : 206-789-7029
Fax Number : 206-789-5485
Authorized Official
Title or Position : AUDIOLOGIST
Name : DR. CHARLES VIRGIL FULMER II
Credential : AUD
Telephone Number : 206-789-7029
Provider Enumeration Date : 07/18/2008
Last Update Date : 07/18/2008

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Directions to “BALLARD SPEECH & HEARING CTR. P.S. ” Practice Location

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