MEDICARE: CAROLINE GORE 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

General Provider Information

NPI Number	:	1811393531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GORE AUD

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	:

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	:

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

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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