Basic Information
| Provider Information | |||||||||
| NPI: | 1801247416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COVINGTON AUDIOLOGY & HEARING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17701 108TH AVE SE | ||||||||
| Address2: | PMB 525 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536393339 | ||||||||
| FaxNumber: | 2536393839 | ||||||||
| Practice Location | |||||||||
| Address1: | 17115 SE 270TH PL STE 104 | ||||||||
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| City: | COVINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980425400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536393339 | ||||||||
| FaxNumber: | 2536393839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | ARBINI | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2536393339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A., CCC-A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | LD 0001101 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1639194665 | 05 | WA | MEDICAID |