Provider Demographics
NPI:1104020148
Name:TEMBREULL, DENNIS JEROME (HIS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JEROME
Last Name:TEMBREULL
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 1:1402 WILLIAMS AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-8468
Mailing Address - Country:US
Mailing Address - Phone:253-535-6386
Mailing Address - Fax:253-535-9723
Practice Address - Street 1:16007 56TH AVENUE CT E
Practice Address - Street 2:SUITE 2
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9004
Practice Address - Country:US
Practice Address - Phone:253-535-6386
Practice Address - Fax:253-535-9723
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0190385OtherLABOR AND INDUSTRIES PROV