Provider Demographics
NPI:1700080868
Name:PROFESSIONAL HEARING AND SPEECH SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING AND SPEECH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCS PRESIDENT
Authorized Official - Phone:253-460-5088
Mailing Address - Street 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:#1H
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-460-5088
Mailing Address - Fax:253-460-5454
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:#1H
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-460-5088
Practice Address - Fax:253-460-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty