Provider Demographics
NPI:1427018985
Name:NILSSON, JOY KATHLEEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:KATHLEEN
Last Name:NILSSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:KATHLEEN
Other - Last Name:REIMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:993 NW DURANGO CT
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8522
Mailing Address - Country:US
Mailing Address - Phone:360-307-8783
Mailing Address - Fax:
Practice Address - Street 1:3311 BETHEL RD SE
Practice Address - Street 2:SUITE #110
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5600
Practice Address - Country:US
Practice Address - Phone:360-895-3347
Practice Address - Fax:360-895-3372
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1174231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS41629Medicare UPIN
WAAB19448Medicare ID - Type Unspecified