Basic Information
| Provider Information | |||||||||
| NPI: | 1073550026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | BC-HIS ACA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 335TH PL SE | ||||||||
| Address2: | BOX 1315 | ||||||||
| City: | FALL CITY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980245899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253580956 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17800 TALBOT RD S | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252775812 | ||||||||
| FaxNumber: | 4252775812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA00000398 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 602987100 | 01 | FEDERAL ID | OTHER | 9056248 | 05 | WA | MEDICAID | 0191898 | 01 | WA | LABOR AND INDUSTRY | OTHER |