Provider Demographics
NPI:1336459197
Name:WHITAKER, RICHARD LOY
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LOY
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15711 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5921
Mailing Address - Country:US
Mailing Address - Phone:206-418-1212
Mailing Address - Fax:
Practice Address - Street 1:15711 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5921
Practice Address - Country:US
Practice Address - Phone:206-418-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60168591237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA60168591OtherWASHINGTON STATE DEPT. OF HEARING -HEARING AID FITTER DISPENSER LICENE