Provider Demographics
NPI:1568993970
Name:BOOTHBY, OLIVIA SIMONE (AUD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SIMONE
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:SIMONE
Other - Last Name:BOOTHBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:X10-ON
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-341-0898
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS:X10-ON
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-341-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61265960231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist