Healthcare Provider Details

I. General information

NPI: 1134867625
Provider Name (Legal Business Name): AVITAL WESTREICH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 COOPER POINT RD NW STE 101
OLYMPIA WA
98502-4462
US

IV. Provider business mailing address

365 COOPER POINT RD NW STE 101
OLYMPIA WA
98502-4462
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7900
  • Fax: 360-704-7909
Mailing address:
  • Phone: 360-704-7900
  • Fax: 360-704-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLD61317082
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD61317082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: