Provider Demographics
NPI:1124881602
Name:FEDERAL WAY AUDIOLOGY, LLC
Entity type:Organization
Organization Name:FEDERAL WAY AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:253-248-6106
Mailing Address - Street 1:34709 9TH AVE S STE B200
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8724
Mailing Address - Country:US
Mailing Address - Phone:253-248-6106
Mailing Address - Fax:
Practice Address - Street 1:34709 9TH AVE S STE B200
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8724
Practice Address - Country:US
Practice Address - Phone:253-248-6106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty