Healthcare Provider Details

I. General information

NPI: 1417176298
Provider Name (Legal Business Name): QUALITY LIFE HEARING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6242 WOODLAWN AVE N
SEATTLE WA
98103-5717
US

IV. Provider business mailing address

6242 WOODLAWN AVE N
SEATTLE WA
98103-5717
US

V. Phone/Fax

Practice location:
  • Phone: 206-235-7595
  • Fax:
Mailing address:
  • Phone: 206-235-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA00002302
License Number StateWA

VIII. Authorized Official

Name: DOROTHY SHERWOOD
Title or Position: OWNER
Credential:
Phone: 206-235-7595