Provider Demographics
NPI:1699874347
Name:SOUTH SOUND AUDIOLOYG LLC
Entity type:Organization
Organization Name:SOUTH SOUND AUDIOLOYG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANAUSDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-A
Authorized Official - Phone:360-789-0097
Mailing Address - Street 1:4444 LACEY BLVD SE
Mailing Address - Street 2:A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5730
Mailing Address - Country:US
Mailing Address - Phone:360-528-2022
Mailing Address - Fax:
Practice Address - Street 1:4444 LACEY BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5730
Practice Address - Country:US
Practice Address - Phone:360-528-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001726231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty