Provider Demographics
NPI:1235749250
Name:WENT, ELISABETH MCKENNA (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:MCKENNA
Last Name:WENT
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 1:19319 7TH AVE NE, SUITE #102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-697-3061
Mailing Address - Fax:360-697-2116
Practice Address - Street 1:19319 7TH AVE NE, SUITE #102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-3061
Practice Address - Fax:360-697-2116
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61081204231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0454758OtherWA L & I