Healthcare Provider Details

I. General information

NPI: 1184023939
Provider Name (Legal Business Name): AUSTIN MCKITTRICK MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/29/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 160
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

505 NE 87TH AVE SUITE 160
VANCOUVER WA
98664-1989
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax: 360-514-1065
Mailing address:
  • Phone: 360-514-6041
  • Fax: 360-514-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGP60482860
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGT60629475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: