| Doctor Name: | BRYAN WALL |
| NPI Number: | 1578863700 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BC-HIS |
| License Number: | HAS-P-509154 |
| Business Practice Address: | 15518 Ne Fargher Lake Hwy Yacolt, WA - 986754508 |
| Business Phone Number: | 3602634000 |
| Business Fax Number: | |
| Mailing Address: | 26916 Ne 434th St, AMBOY |
| State: | WA |
| Postal Code: | 986014636 |
| Phone Number: | 3602476590 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2010 |
| NPI Last Update Date: | 10/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | HAS-P-509154 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |