Provider Demographics
NPI:1033158100
Name:BECKEN, AMY MARIA (AUD, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIA
Last Name:BECKEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:SUITE #211
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-373-1250
Mailing Address - Fax:360-373-0834
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:SUITE #211
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4203
Practice Address - Country:US
Practice Address - Phone:360-373-1250
Practice Address - Fax:360-373-0834
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA966231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7048556Medicaid
WA7048556Medicaid