Provider Demographics
NPI:1871968974
Name:MAGNUSSON, PAUL (BC-HIS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3917
Mailing Address - Country:US
Mailing Address - Phone:360-736-6283
Mailing Address - Fax:360-736-2928
Practice Address - Street 1:407 S TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3917
Practice Address - Country:US
Practice Address - Phone:360-736-6283
Practice Address - Fax:360-736-2928
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA609237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist