Provider Demographics
NPI:1942410634
Name:GARNETT, JEFFREY LEE (MS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:GARNETT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16209 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9034
Mailing Address - Country:US
Mailing Address - Phone:360-892-3445
Mailing Address - Fax:360-213-2044
Practice Address - Street 1:16209 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9034
Practice Address - Country:US
Practice Address - Phone:360-892-3445
Practice Address - Fax:360-213-2044
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001465231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115954Medicaid