Provider Demographics
NPI:1881908721
Name:BOTHWELL, JEREMY (AAS-HIS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BOTHWELL
Suffix:
Gender:M
Credentials:AAS-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9502 N NEWPORT HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1147
Mailing Address - Country:US
Mailing Address - Phone:509-315-5410
Mailing Address - Fax:509-315-5411
Practice Address - Street 1:9502 N NEWPORT HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1147
Practice Address - Country:US
Practice Address - Phone:509-315-5410
Practice Address - Fax:509-315-5411
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60023114237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist