Provider Demographics
NPI:1679654321
Name:JARRELL, KRISTINE LIANE (AUD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LIANE
Last Name:JARRELL
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 1:20 NW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3103
Mailing Address - Country:US
Mailing Address - Phone:360-678-1423
Mailing Address - Fax:360-678-1769
Practice Address - Street 1:20 NW BIRCH ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3103
Practice Address - Country:US
Practice Address - Phone:360-678-1423
Practice Address - Fax:360-678-1769
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001170231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9053034Medicaid
WA7109754Medicaid
WAAB25897Medicare PIN
WA7109754Medicaid