Provider Demographics
NPI:1568632594
Name:HEARING HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:HEARING HEALTHCARE CENTER, INC.
Other - Org Name:HEARING HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUTAANSUU
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:360-491-9733
Mailing Address - Street 1:3525 ENSIGN RD NE STE M1
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-491-9733
Mailing Address - Fax:360-493-1943
Practice Address - Street 1:3525 ENSIGN RD NE STE M1
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-491-9733
Practice Address - Fax:360-493-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X, 261QH0700X
WALD00001057332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7093891Medicaid
WA9047473Medicaid
WAAB09729Medicare PIN
WA9047473Medicaid
WAS52386Medicare UPIN