Healthcare Provider Details

I. General information

NPI: 1073684692
Provider Name (Legal Business Name): SOUTH SOUND PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 12TH AVE NE
OLYMPIA WA
98506-5218
US

IV. Provider business mailing address

3516 12TH AVE NE
OLYMPIA WA
98506-5218
US

V. Phone/Fax

Practice location:
  • Phone: 360-456-1600
  • Fax: 360-456-6504
Mailing address:
  • Phone: 360-456-1600
  • Fax: 360-456-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BETH HARVEY
Title or Position: MEDICAL DIRECTOR/PARTNER
Credential: MD
Phone: 360-456-1600