Provider Demographics
NPI:1083939037
Name:JEWETT, TRACY G (HIS)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:G
Last Name:JEWETT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1321
Mailing Address - Country:US
Mailing Address - Phone:509-698-4327
Mailing Address - Fax:509-698-3382
Practice Address - Street 1:115 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1321
Practice Address - Country:US
Practice Address - Phone:509-698-4327
Practice Address - Fax:509-698-3382
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA925237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist