Healthcare Provider Details

I. General information

NPI: 1871968974
Provider Name (Legal Business Name): PAUL MAGNUSSON BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARTIN WAY E STE A
OLYMPIA WA
98506-4974
US

IV. Provider business mailing address

407 S TOWER AVE
CENTRALIA WA
98531-3917
US

V. Phone/Fax

Practice location:
  • Phone: 360-464-2499
  • Fax: 360-252-7329
Mailing address:
  • Phone: 360-736-6283
  • Fax: 360-736-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00000609
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: