Healthcare Provider Details

I. General information

NPI: 1457723728
Provider Name (Legal Business Name): CRAIG HERTZ BC-HIS, IHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15881 LORDS LAKE AVE SE
MONROE WA
98272-2860
US

IV. Provider business mailing address

15881 LORDS LAKE AVE SE
MONROE WA
98272-2860
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-0654
  • Fax:
Mailing address:
  • Phone: 360-805-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number00000657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: