Healthcare Provider Details

I. General information

NPI: 1306985221
Provider Name (Legal Business Name): REBECCA ANN MOONEY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN HENDON

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRISTOL CT. SW STE B-104
OLYMPIA WA
98502
US

IV. Provider business mailing address

10564 5TH AVE NE STE 203
SEATTLE WA
98125-7200
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-0305
  • Fax: 360-596-9304
Mailing address:
  • Phone: 206-367-1345
  • Fax: 206-367-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLD00001056
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00001056
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: