Healthcare Provider Details

I. General information

NPI: 1285777102
Provider Name (Legal Business Name): AIDAH ESAREY M.S., FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W POPLAR ST STE 210
WALLA WALLA WA
99362-2858
US

IV. Provider business mailing address

PO BOX 34439
SEATTLE WA
98124-1439
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-5825
  • Fax: 509-529-3512
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00001071
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: