Provider Demographics
NPI:1073917951
Name:RANDALL, JENCI (AUD)
Entity Type:Individual
Prefix:MS
First Name:JENCI
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-0880
Mailing Address - Country:US
Mailing Address - Phone:419-234-6629
Mailing Address - Fax:
Practice Address - Street 1:601 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-6305
Practice Address - Country:US
Practice Address - Phone:509-962-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60518616231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist