Provider Demographics
NPI:1326487729
Name:MAPLE VALLEY HEARING AIDS LLC
Entity Type:Organization
Organization Name:MAPLE VALLEY HEARING AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-432-1207
Mailing Address - Street 1:22126 SE 237TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8533
Mailing Address - Country:US
Mailing Address - Phone:425-432-1207
Mailing Address - Fax:425-413-4465
Practice Address - Street 1:22126 SE 237TH ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8533
Practice Address - Country:US
Practice Address - Phone:425-432-1207
Practice Address - Fax:425-413-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60210066237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty