Healthcare Provider Details

I. General information

NPI: 1104303791
Provider Name (Legal Business Name): PNW AUDIOLOGY SPECIALTY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 3RD AVE NE STE 201
SEATTLE WA
98115-2023
US

IV. Provider business mailing address

9730 3RD AVE NE STE 201
SEATTLE WA
98115-2023
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-1345
  • Fax: 206-367-1366
Mailing address:
  • Phone: 206-367-1345
  • Fax: 206-367-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MELANIE HECKER
Title or Position: OWNER/AUDIOLOGIST
Credential:
Phone: 206-367-1345