Provider Demographics
NPI:1679773410
Name:PENINSULA AUDIOLOGY & HEARING AIDS, P.S.
Entity type:Organization
Organization Name:PENINSULA AUDIOLOGY & HEARING AIDS, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:253-858-3277
Mailing Address - Street 1:3212 50TH STREET CT NW STE 105
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8527
Mailing Address - Country:US
Mailing Address - Phone:253-858-3277
Mailing Address - Fax:253-858-6299
Practice Address - Street 1:3212 50TH STREET CT NW STE 105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8527
Practice Address - Country:US
Practice Address - Phone:253-858-3277
Practice Address - Fax:253-858-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00000965231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7040496Medicaid
WACK5419OtherRAILROAD MEDICARE
WARA5863OtherREGENCE
WA5398207OtherAETNA
WA0157117OtherWA STATE DEPT OF LABOR AN
WA5398207OtherAETNA