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General NPI Number Information
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NPI Number | 1669637633
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Entity Type | Organization
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Legal Business Name | BALLARD SPEECH & HEARING CTR. P.S.
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 5428 BARNES AVE NW
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City | SEATTLE
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State | WA
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Zip | 98107-3839
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Country | US
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Telephone | 206-789-7029
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Fax | 206-789-5485
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Provider Business Mailing Address
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Address Line | 5428 BARNES AVE NW
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City | SEATTLE
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State | WA
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Zip | 98107-3839
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Country | US
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Telephone | 206-789-7029
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Fax | 206-789-5485
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | DR. CHARLES VIRGIL FULMER II
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Credential | AUD
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Telephone | 206-789-7029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | LD00000978
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License Number State | WA
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