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Individual

VICKI A DESHAZO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
208 BELLEVUE WAY NE, BELLEVUE, WA 98004-5720
(425) 455-5596
(425) 451-3248
Mailing address
208 BELLEVUE WAY NE, BELLEVUE, WA 98004-5720
(425) 455-5596
(425) 451-3248

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
LD00002762
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1092881
WA
01
8450512
MEDICAID
WA
Enumeration date
05/18/2006
Last updated
10/21/2013
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