Healthcare Provider Details

I. General information

NPI: 1376715862
Provider Name (Legal Business Name): ADVANCED HEARING AND SPEECH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 N NATIONAL AVE SUITE 101
CHEHALIS WA
98532-2215
US

IV. Provider business mailing address

PO BOX 148
SALKUM WA
98582-0148
US

V. Phone/Fax

Practice location:
  • Phone: 360-740-8992
  • Fax: 360-740-8993
Mailing address:
  • Phone: 360-740-8992
  • Fax: 360-740-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA RAE GANTRY-DOTSON
Title or Position: PRESIDENT
Credential: MSSLP/A,CCC
Phone: 360-740-8992