Provider Demographics
NPI:1174657464
Name:NORTHWEST VESTIBULAR SERVICES, PLLC
Entity Type:Organization
Organization Name:NORTHWEST VESTIBULAR SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:206-325-0645
Mailing Address - Street 1:418 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4018
Mailing Address - Country:US
Mailing Address - Phone:206-325-0645
Mailing Address - Fax:206-283-9815
Practice Address - Street 1:418 1ST AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4018
Practice Address - Country:US
Practice Address - Phone:206-325-0645
Practice Address - Fax:206-283-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACD00001153231H00000X, 231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0209957OtherL&I
WAG8850208Medicare PIN