Healthcare Provider Details

I. General information

NPI: 1073938411
Provider Name (Legal Business Name): SHAWN PHILIP UTIGARD HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 HOLMAN RD NW STE. 101
SEATTLE WA
98117-2000
US

IV. Provider business mailing address

9776 HOLMAN RD NW STE. 101
SEATTLE WA
98117-2000
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-6770
  • Fax: 206-957-6003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00000409
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: