Organization
PROVAIL
Active
Other names
PROVAIL Therapeutic and Assistive Technology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HATZENBELER (CEO)
(206) 363-7303
Entity
Organization
Contact information
Practice address
12550 AURORA AVE N, SEATTLE, WA 98133-8036
(206) 363-7303
(206) 826-0181
Mailing address
12550 AURORA AVE N, SEATTLE, WA 98133-8036
(206) 363-7303
(206) 826-0181
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SI00004391
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
397572001
GROUP HEALTH PROVIDER NUM
WA
01
—
55-0174569
LABOR AND INDUSTRIES
WA
05
—
7070949-8347395
—
WA
05
—
7070949-8347429
—
WA
01
—
7368087
AETNA CLINIC NUMBER
WA
05
—
7681083-8415291
—
WA
05
—
7681083-8464992
—
WA
Enumeration date
05/16/2007
Last updated
06/21/2018
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