Provider Demographics
NPI:1962627307
Name:AULT, ARTHUR RAY (NBCHIS)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:RAY
Last Name:AULT
Suffix:
Gender:M
Credentials:NBCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3028
Mailing Address - Country:US
Mailing Address - Phone:425-771-3049
Mailing Address - Fax:425-771-5350
Practice Address - Street 1:104 5TH AVE N
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3145
Practice Address - Country:US
Practice Address - Phone:425-771-3886
Practice Address - Fax:425-771-5350
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA66370OtherLABOR & INDUSTRIES
WA9039447Medicaid