Provider Demographics
NPI:1003032772
Name:VANAUSDAL, JULIE K (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:VANAUSDAL
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:LARSEN-VANAUSDAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:4444 LACEY BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5730
Mailing Address - Country:US
Mailing Address - Phone:360-528-2020
Mailing Address - Fax:
Practice Address - Street 1:4444 LACEY BLVD SE
Practice Address - Street 2:SUITE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5730
Practice Address - Country:US
Practice Address - Phone:360-528-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001726231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8865137Medicare PIN