Provider Demographics
NPI:1669637633
Name:BALLARD SPEECH & HEARING CTR. P.S.
Entity Type:Organization
Organization Name:BALLARD SPEECH & HEARING CTR. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:II
Authorized Official - Credentials:AUD
Authorized Official - Phone:206-789-7029
Mailing Address - Street 1:5428 BARNES AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3839
Mailing Address - Country:US
Mailing Address - Phone:206-789-7029
Mailing Address - Fax:206-789-5485
Practice Address - Street 1:5428 BARNES AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3839
Practice Address - Country:US
Practice Address - Phone:206-789-7029
Practice Address - Fax:206-789-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00000978291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1427137447OtherPERSONAL NPI