Basic Information
| Provider Information | |||||||||
| NPI: | 1962627307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AULT | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NBCHIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 GLEN ST | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980203028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257713049 | ||||||||
| FaxNumber: | 4257715350 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 5TH AVE N | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980203145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257713886 | ||||||||
| FaxNumber: | 4257715350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 66370 | 01 | WA | LABOR & INDUSTRIES | OTHER | 9039447 | 05 | WA | MEDICAID |