Provider Demographics
NPI:1225346257
Name:AEILLO, KIM M (MA, CCC-A FAAA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:AEILLO
Suffix:
Gender:F
Credentials:MA, CCC-A FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2033
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-6033
Mailing Address - Country:US
Mailing Address - Phone:360-914-8809
Mailing Address - Fax:
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-4927
Practice Address - Country:US
Practice Address - Phone:360-257-9925
Practice Address - Fax:360-257-5310
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU000032231H00000X, 237600000X
KS575231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter