Provider Demographics
NPI:1164422028
Name:HALL, JO KOENIG (CCC-A)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:KOENIG
Last Name:HALL
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:206-987-5770
Mailing Address - Fax:206-987-5779
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 400
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:206-987-5770
Practice Address - Fax:206-987-5779
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8329286Medicaid
WA9713KOOtherREGENCE BS RIDER #
WA0195901OtherLABOR AND INDUSTRIES
WA9713KOOtherREGENCE BS RIDER #