Basic Information
| Provider Information | |||||||||
| NPI: | 1639386980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NW AUDIOLOGY, INC. | ||||||||
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| OtherOrganizationName: | STANWOOD CAMANO HEARING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7359 267TH ST. NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606296554 | ||||||||
| FaxNumber: | 3606295454 | ||||||||
| Practice Location | |||||||||
| Address1: | 7359 267TH ST. NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606296554 | ||||||||
| FaxNumber: | 3606295454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANFORD | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | WYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3606296554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA, CCC-A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2140 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.