Individual
BRYAN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BC-HIS
Contact information
Practice address
15518 NE FARGHER LAKE HWY, YACOLT, WA 98675-4508
(360) 263-4000
Mailing address
26916 NE 434TH ST, AMBOY, WA 98601-4636
(360) 247-6590
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA 00004733
WA
237700000X
Hearing Instrument Specialist
HAS-P-509154
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LNI 254658
SATET OF WASHINGTON L&I PROVIDER
WA
Enumeration date
10/21/2010
Last updated
10/21/2010
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