Provider Demographics
NPI:1811195530
Name:HISEY, JOHN D (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HISEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 SPRINGWATER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1561
Mailing Address - Country:US
Mailing Address - Phone:509-663-3967
Mailing Address - Fax:509-663-2899
Practice Address - Street 1:1129 SPRINGWATER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1561
Practice Address - Country:US
Practice Address - Phone:509-663-3967
Practice Address - Fax:509-663-2899
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA988231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist