Provider Demographics
NPI:1225488422
Name:REESE, KORI REBECCA (HIS)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:REBECCA
Last Name:REESE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ST HELENS AVE
Mailing Address - Street 2:APT 502
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2594
Mailing Address - Country:US
Mailing Address - Phone:619-370-2877
Mailing Address - Fax:360-704-7909
Practice Address - Street 1:365 COOPER POINT RD NW
Practice Address - Street 2:SUITE #102
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4462
Practice Address - Country:US
Practice Address - Phone:360-704-7900
Practice Address - Fax:360-704-7909
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60647804237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist