Provider Demographics
NPI:1649009424
Name:BEUTLER, NATHANIEL ADAM (AUD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ADAM
Last Name:BEUTLER
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 1:9425 SANDIFUR PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8083
Mailing Address - Country:US
Mailing Address - Phone:509-492-4951
Mailing Address - Fax:
Practice Address - Street 1:9425 SANDIFUR PKWY STE 103
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8083
Practice Address - Country:US
Practice Address - Phone:509-492-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61580047231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist