Provider Demographics
NPI:1497337307
Name:PENINSULA FAMILY HEARING
Entity Type:Organization
Organization Name:PENINSULA FAMILY HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ HEARING AID DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDSCH
Authorized Official - Suffix:
Authorized Official - Credentials:AAS HIS, COHC
Authorized Official - Phone:425-361-6257
Mailing Address - Street 1:830 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6419
Mailing Address - Country:US
Mailing Address - Phone:360-504-3900
Mailing Address - Fax:360-504-3905
Practice Address - Street 1:830 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6419
Practice Address - Country:US
Practice Address - Phone:360-504-3900
Practice Address - Fax:360-504-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2200397Medicaid