Provider Demographics
NPI:1629650338
Name:AUSTIN, ILEANA D
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:D
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21849 SE 266TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6133
Mailing Address - Country:US
Mailing Address - Phone:425-269-3528
Mailing Address - Fax:
Practice Address - Street 1:21849 SE 266TH PL
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6133
Practice Address - Country:US
Practice Address - Phone:425-269-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC54753171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345678OtherMEDICAL INTERPRETER