Active NPI
Glen Warren Rovig, MA, CCC-A
- Audiologist
- Bremerton, WA
National Provider Identifier
1396735536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 147.000470
- Practice address
- 1 Boone Rd
Bremerton, WA 98312-1894 - Phone
- (360) 475-4214
- Fax
- (360) 475-4214
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 147.000470 | IL | Primary |
Addresses
Primary practice location
1 Boone Rd
Bremerton, WA 98312-1894
Mailing address
1 Boone Rd
Bremerton, WA 98312-1894
Phone (360) 475-4214
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147.000470 | IL | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258588800000",
"number": "1396735536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121894",
"telephone_number": "360-475-4214",
"fax_number": "360-475-4214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121894",
"telephone_number": "360-475-4214",
"fax_number": "360-475-4214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROVIG",
"first_name": "GLEN",
"middle_name": "WARREN",
"name_prefix": "Mr.",
"credential": "MA, CCC-A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2009-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "IL",
"license": "147.000470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.