Provider Demographics
NPI:1306985221
Name:MOONEY, REBECCA ANN (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:HENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10564 5TH AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-367-1345
Mailing Address - Fax:206-367-1366
Practice Address - Street 1:2401 BRISTOL CT. SW
Practice Address - Street 2:STE B-104
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-754-0305
Practice Address - Fax:360-596-9304
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001056237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8393555Medicaid
WA8393555Medicaid
WAG8809513Medicare PIN
WAG8872475Medicare PIN