Basic Information
| Provider Information | |||||||||
| NPI: | 1134867625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTREICH | ||||||||
| FirstName: | AVITAL | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 COOPER POINT RD NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985024462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607047900 | ||||||||
| FaxNumber: | 3607047909 | ||||||||
| Practice Location | |||||||||
| Address1: | 365 COOPER POINT RD NW STE 101 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985024462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607047900 | ||||||||
| FaxNumber: | 3607047909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | LD61317082 | WA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | LD61317082 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.