Provider Demographics
NPI:1508899220
Name:BLOCK, JONELL MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:JONELL
Middle Name:MARIE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0820
Mailing Address - Country:US
Mailing Address - Phone:509-994-4395
Mailing Address - Fax:509-207-7118
Practice Address - Street 1:203 N EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0820
Practice Address - Country:US
Practice Address - Phone:509-994-4395
Practice Address - Fax:509-207-7118
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00003482231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7124522Medicaid
WA9055823Medicaid
WA7124522Medicaid