MEDICARE: DR. STACEY B BARGMEYER-HUTCHISON AUD

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	LD00003855	WA

General Provider Information

NPI Number	:	1780876680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY B BARGMEYER-HUTCHISON AUD

Provider Business Mailing Address
First Line	:	49 FRONT ST N
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-3237
Country	:	US
Telephone Number	:	425-391-3343
Fax Number	:	425-391-5692

Provider Business Practice Location Address
First Line	:	49 FRONT ST N
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-3237
Country	:	US
Telephone Number	:	425-391-3343
Fax Number	:	425-391-5692

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	10/01/2009

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