1750570347 NPI number — KELLEY POWERS AUDIOLOGY, P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750570347 NPI number — KELLEY POWERS AUDIOLOGY, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLEY POWERS AUDIOLOGY, P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750570347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10016 LOOKOUT DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-9713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-8944
Provider Business Mailing Address Fax Number:
360-330-8943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 COOKS HILL RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-9068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-330-8944
Provider Business Practice Location Address Fax Number:
360-330-8943
Provider Enumeration Date:
10/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POWERS
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-330-8944

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  LD00002125 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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