Basic Information
| Provider Information | |||||||||
| NPI: | 1891865416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEATING | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5570 HARBOR AVE | ||||||||
| Address2: | UNIT B | ||||||||
| City: | FREELAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982493007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602791229 | ||||||||
| FaxNumber: | 3602791209 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 SE MIDWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602791229 | ||||||||
| FaxNumber: | 3602791209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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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 | 231H00000X | LD00002267 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 7109754 | 05 | WA | MEDICAID | 9053034 | 05 | WA | MEDICAID |