Healthcare Provider Details

I. General information

NPI: 1326869298
Provider Name (Legal Business Name): GOLD STAR AUDIOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MASON RUNN LN
RISING SUN MD
21911-1699
US

IV. Provider business mailing address

16209 SE MCGILLIVRAY BLVD STE M
VANCOUVER WA
98683-9034
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-3445
  • Fax: 360-213-2044
Mailing address:
  • Phone: 360-892-3445
  • Fax: 360-213-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER EUGENE LAWSON
Title or Position: OWNER
Credential: AUD
Phone: 360-892-3445