Provider Demographics
NPI:1346659984
Name:ADAMS, MARK (HIS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ADAMS
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 1:10413 BEARDSLEE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3463
Mailing Address - Country:US
Mailing Address - Phone:425-485-6403
Mailing Address - Fax:425-486-5037
Practice Address - Street 1:10413 BEARDSLEE BLVD
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3463
Practice Address - Country:US
Practice Address - Phone:425-485-6403
Practice Address - Fax:425-486-5037
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00000420237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist