Provider Demographics
NPI:1538796289
Name:AULT, CORRIE ELIZABETH
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:ELIZABETH
Last Name:AULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 NE 153RD PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4690
Mailing Address - Country:US
Mailing Address - Phone:425-270-1789
Mailing Address - Fax:
Practice Address - Street 1:8013 NE 153RD PL
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4690
Practice Address - Country:US
Practice Address - Phone:425-270-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4931171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter