Provider Demographics
NPI:1346360484
Name:POWERS, KELLEY ANN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANN
Last Name:POWERS
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 1:10016 LOOKOUT DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9713
Mailing Address - Country:US
Mailing Address - Phone:360-330-8944
Mailing Address - Fax:360-330-8943
Practice Address - Street 1:128 LILLY RD NE
Practice Address - Street 2:SUITE #202
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-7400
Practice Address - Country:US
Practice Address - Phone:360-357-6314
Practice Address - Fax:360-705-3745
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002125231H00000X, 231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058397Medicaid
WA7107295Medicaid
WA7107295Medicaid