Provider Demographics
NPI:1114072428
Name:RAND, SHANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANN
Middle Name:
Last Name:RAND
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 1:3212 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
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00000965231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARA5863OtherREGENCE BLUE SHIELD
WA0157117OtherDEPARTMENT OF LABOR & IND
WA5398207OtherAETNA
WA7040496Medicaid
WACK5419OtherRAILROAD MEDICARE
WA96248OtherHEAR PO
WAGAB27301Medicare ID - Type Unspecified