Healthcare Provider Details

I. General information

NPI: 1487876702
Provider Name (Legal Business Name): CAROLYN L HARESTAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33515 10 PL SO BUILDING 13
FEDERAL WAY WA
98003-7300
US

IV. Provider business mailing address

33515 10 PL SO BUILDING 13
FEDERAL WAY WA
98003-7300
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-2599
  • Fax: 253-874-2392
Mailing address:
  • Phone: 253-874-2599
  • Fax: 253-874-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateWA

VIII. Authorized Official

Name: CAROLYN L HARESTAD
Title or Position: OWNER
Credential: MA CCC S
Phone: 253-874-2599