Provider Demographics
NPI:1194193292
Name:PENINSULA HEARING TECH
Entity Type:Organization
Organization Name:PENINSULA HEARING TECH
Other - Org Name:PENINSULA AUDIOLOGY AND HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONDICT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:903-816-2836
Mailing Address - Street 1:3212 50TH STREET CT NW STE 100
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:
Practice Address - Street 1:3212 50TH STREET CT NW STE 100
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60282050231H00000X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty