Provider Demographics
NPI:1780994848
Name:GROLLEY, EVAN CHARLES (AUD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:CHARLES
Last Name:GROLLEY
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 1:9576 RIDGETOP BLVD NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8554
Mailing Address - Country:US
Mailing Address - Phone:360-551-4800
Mailing Address - Fax:360-551-4801
Practice Address - Street 1:9576 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8554
Practice Address - Country:US
Practice Address - Phone:360-551-4800
Practice Address - Fax:360-551-4801
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60281651231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist