Provider Demographics
NPI:1235524455
Name:GAVRONSKI, EDWARD (AT,HAS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:GAVRONSKI
Suffix:
Gender:M
Credentials:AT,HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 EDGEWOOD AVE SW APT 6
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1289
Mailing Address - Country:US
Mailing Address - Phone:253-579-8617
Mailing Address - Fax:253-475-5597
Practice Address - Street 1:4502 S STEELE ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7226
Practice Address - Country:US
Practice Address - Phone:253-475-5587
Practice Address - Fax:253-475-5597
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60371050237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter