Provider Demographics
NPI:1336318310
Name:HARBOR AUDIOLOGY & HEARING SERVICES INC
Entity Type:Organization
Organization Name:HARBOR AUDIOLOGY & HEARING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-851-3932
Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:#212
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-851-3932
Mailing Address - Fax:253-851-4216
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:#212
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-851-3932
Practice Address - Fax:253-851-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0A9845OtherREGENCY
WA7091218Medicaid
WAG8802835Medicare PIN
WA0A9845OtherREGENCY