Provider Demographics
NPI:1568004638
Name:BEARHEART THERAPIES LLC
Entity Type:Organization
Organization Name:BEARHEART THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VIANELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:360-821-3820
Mailing Address - Street 1:4611 NE 118TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-5994
Mailing Address - Country:US
Mailing Address - Phone:916-267-7262
Mailing Address - Fax:360-925-3367
Practice Address - Street 1:4611 NE 118TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5994
Practice Address - Country:US
Practice Address - Phone:916-267-7262
Practice Address - Fax:360-925-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487977435Medicaid