Healthcare Provider Details

I. General information

NPI: 1316580137
Provider Name (Legal Business Name): TIA C. MCDONALD AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 27TH AVE SE
PUYALLUP WA
98374-1145
US

IV. Provider business mailing address

PO BOX 1205
PUYALLUP WA
98371-0231
US

V. Phone/Fax

Practice location:
  • Phone: 253-770-9000
  • Fax: 253-770-9712
Mailing address:
  • Phone: 253-770-9000
  • Fax: 253-770-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD61444878
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLD61444878
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberLD61444878
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberLD61444878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: