Provider Demographics
NPI:1073938411
Name:UTIGARD, SHAWN PHILIP (HIS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PHILIP
Last Name:UTIGARD
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 HOLMAN RD NW
Mailing Address - Street 2:STE. 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9776 HOLMAN RD NW
Practice Address - Street 2:STE. 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2000
Practice Address - Country:US
Practice Address - Phone:206-782-6770
Practice Address - Fax:206-957-6003
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00000409237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist