Basic Information
| Provider Information | |||||||||
| NPI: | 1114057411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPPARELLI | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6724 SE 114TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972664966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034216094 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11516 SE MILL PLAIN BLVD STE 2J | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986845082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608828027 | ||||||||
| FaxNumber: | 3608828030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 10/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-1001628 | OR | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HA 60325844 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2031096 | 05 | WA | MEDICAID |