Healthcare Provider Details

I. General information

NPI: 1134041478
Provider Name (Legal Business Name): MACIE ROSE YVONNE HAYWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 WASHINGTON WAY STE 111
LONGVIEW WA
98632-4059
US

IV. Provider business mailing address

5517 E E ST
TACOMA WA
98404-2055
US

V. Phone/Fax

Practice location:
  • Phone: 971-328-4763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: