Provider Demographics
NPI:1376715862
Name:ADVANCED HEARING AND SPEECH INC
Entity Type:Organization
Organization Name:ADVANCED HEARING AND SPEECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GANTRY-DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSSLP/A,CCC
Authorized Official - Phone:360-740-8992
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:SALKUM
Mailing Address - State:WA
Mailing Address - Zip Code:98582-0148
Mailing Address - Country:US
Mailing Address - Phone:360-740-8992
Mailing Address - Fax:360-740-8993
Practice Address - Street 1:1570 N NATIONAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2215
Practice Address - Country:US
Practice Address - Phone:360-740-8992
Practice Address - Fax:360-740-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9060328OtherHEARING AID
8806567OtherPERSONAL NUMBER
7035900OtherMEDICAID, SPEECH
WA7126261Medicaid
G8806565Medicare PIN