Provider Demographics
NPI:1437734191
Name:ISBELLE, JENNIFER KATHRYN (HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:ISBELLE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2208
Mailing Address - Country:US
Mailing Address - Phone:541-397-0074
Mailing Address - Fax:
Practice Address - Street 1:302 E 4TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2208
Practice Address - Country:US
Practice Address - Phone:541-397-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61041788237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61041788OtherWASHINGTON STATE HEARING AID DISPENSING LICENSE