Provider Demographics
NPI:1528247350
Name:KILLINGSWORTH, CAROL A (AUD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:ROTTGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 FRONT ST N
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3237
Mailing Address - Country:US
Mailing Address - Phone:425-392-1161
Mailing Address - Fax:425-391-5692
Practice Address - Street 1:49 FRONT ST N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3237
Practice Address - Country:US
Practice Address - Phone:425-392-1161
Practice Address - Fax:425-391-5692
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001153231H00000X, 231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0209957OtherL&I
WA7126048Medicaid
WAG8850209Medicare PIN