Provider Demographics
NPI:1972713881
Name:AUDIOLOGISTS NORTHWEST
Entity Type:Organization
Organization Name:AUDIOLOGISTS NORTHWEST
Other - Org Name:LYNN E. BYRNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPA
Authorized Official - Phone:360-479-4065
Mailing Address - Street 1:1411 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4427
Mailing Address - Country:US
Mailing Address - Phone:360-479-4065
Mailing Address - Fax:360-479-3820
Practice Address - Street 1:1411 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4427
Practice Address - Country:US
Practice Address - Phone:360-479-4065
Practice Address - Fax:360-479-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001002261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9420100Medicaid
WA0072198OtherL&I
WA192394400OtherOWCP
WA=========OtherEIN
WA000200214Medicare ID - Type Unspecified