Provider Demographics
NPI:1326181108
Name:GARRETT, MAVIS W (AUD,)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:W
Last Name:GARRETT
Suffix:
Gender:F
Credentials:AUD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 THIMBLE SHOALS BLVD STE C-3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2576
Mailing Address - Country:US
Mailing Address - Phone:757-873-8794
Mailing Address - Fax:757-873-5734
Practice Address - Street 1:703 THIMBLE SHOALS BLVD STE C-3
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2576
Practice Address - Country:US
Practice Address - Phone:757-873-8794
Practice Address - Fax:757-873-5734
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000195231H00000X
VA2101000379237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter