Healthcare Provider Details

I. General information

NPI: 1578561817
Provider Name (Legal Business Name): REBECCA A GRADY MA.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA A BROSEKE BOWLUS MA

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SW 148TH ST STE 101
BURIEN WA
98166-1975
US

IV. Provider business mailing address

457 SW 148TH ST STE 101
BURIEN WA
98166-1975
US

V. Phone/Fax

Practice location:
  • Phone: 206-246-8677
  • Fax: 206-431-2922
Mailing address:
  • Phone: 206-633-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberL000001464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: