Provider Demographics
NPI:1669025987
Name:PALL, MATTHEW JUDE (AUD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JUDE
Last Name:PALL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 JAHN AVE NW STE A4
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8905
Mailing Address - Country:US
Mailing Address - Phone:615-610-6353
Mailing Address - Fax:360-230-3189
Practice Address - Street 1:2601 JAHN AVE NW STE A4
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8905
Practice Address - Country:US
Practice Address - Phone:615-610-6353
Practice Address - Fax:360-230-3189
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60966020231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist