Healthcare Provider Details

I. General information

NPI: 1306053269
Provider Name (Legal Business Name): AUDIOLOGY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 150
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

505 NE 87TH AVE SUITE 150
VANCOUVER WA
98664-1989
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-9367
  • Fax: 360-253-3801
Mailing address:
  • Phone: 360-892-9367
  • Fax: 360-253-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberLD00001627
License Number StateWA

VIII. Authorized Official

Name: MRS. NANCY M. BOWEN
Title or Position: VICE PRESIDENT
Credential: MS-CCC
Phone: 360-892-9367