Provider Demographics
NPI:1750570347
Name:KELLEY POWERS AUDIOLOGY, P.S.
Entity type:Organization
Organization Name:KELLEY POWERS AUDIOLOGY, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-330-8944
Mailing Address - Street 1:10016 LOOKOUT DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9713
Mailing Address - Country:US
Mailing Address - Phone:360-330-8944
Mailing Address - Fax:360-330-8943
Practice Address - Street 1:1800 COOKS HILL RD
Practice Address - Street 2:SUITE K
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9068
Practice Address - Country:US
Practice Address - Phone:360-330-8944
Practice Address - Fax:360-330-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002125261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech