MEDICARE: SUSAN K HEALEA MA-CCCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	LD00000957	WA
2	237600000X	Audiologist-Hearing Aid Fitter	LD00000957	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06222	OTHER	WA	REGENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0123184	OTHER	WA	L&I

General Provider Information

NPI Number	:	1912947722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN K HEALEA MA-CCCA

Provider Business Mailing Address
First Line	:	820 11TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2402
Country	:	US
Telephone Number	:	360-423-0960
Fax Number	:	360-423-8778

Provider Business Practice Location Address
First Line	:	820 11TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2402
Country	:	US
Telephone Number	:	360-423-0960
Fax Number	:	360-423-8778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	02/29/2008

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