Provider Demographics
NPI:1497095830
Name:KITSAP AUDIOLOGY & HEARING AID CLINIC, PLLC
Entity Type:Organization
Organization Name:KITSAP AUDIOLOGY & HEARING AID CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECKEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:360-373-1250
Mailing Address - Street 1:2601 CHERRY AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4208
Mailing Address - Country:US
Mailing Address - Phone:360-373-1250
Mailing Address - Fax:360-373-0834
Practice Address - Street 1:2601 CHERRY AVE STE 211
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4208
Practice Address - Country:US
Practice Address - Phone:360-373-1250
Practice Address - Fax:360-373-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD 00000966332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment