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General NPI Number Information
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NPI Number | 1699874347
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Entity Type | Organization
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Legal Business Name | SOUTH SOUND AUDIOLOYG LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 4444 LACEY BLVD SE
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City | LACEY
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State | WA
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Zip | 98503-5730
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Country | US
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Telephone | 360-528-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 LACEY BLVD SE A
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City | LACEY
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State | WA
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Zip | 98503-5730
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Country | US
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Telephone | 360-528-2022
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JULIE K VANAUSDAL
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Credential | M.S. CCC-A
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Telephone | 360-789-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | LD00001726
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License Number State | WA
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