Provider Demographics
NPI:1952822660
Name:HASKINS, KRISTIAN THOMAS WORKMAN (HIS)
Entity Type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:THOMAS WORKMAN
Last Name:HASKINS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98353-0600
Mailing Address - Country:US
Mailing Address - Phone:360-710-4450
Mailing Address - Fax:
Practice Address - Street 1:1328 COLCHESTER DRIVE S.E.
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-710-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60680306237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA60680306OtherHEARING AID SPECIALIST LICENSE