Healthcare Provider Details

I. General information

NPI: 1174657464
Provider Name (Legal Business Name): NORTHWEST VESTIBULAR SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 1ST AVE W
SEATTLE WA
98119-4018
US

IV. Provider business mailing address

418 1ST AVE W
SEATTLE WA
98119-4018
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-0645
  • Fax: 206-283-9815
Mailing address:
  • Phone: 206-325-0645
  • Fax: 206-283-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberCD00001153
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberCD00001153
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberCD00001153
License Number StateWA

VIII. Authorized Official

Name: CAROL KILLINGSWORTH
Title or Position: OWNER
Credential: AUD
Phone: 206-325-0645