Provider Demographics
NPI:1831730597
Name:LEONG, MARCI KIM (AUD)
Entity type:Individual
Prefix:DR
First Name:MARCI
Middle Name:KIM
Last Name:LEONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4257 134TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2145
Mailing Address - Country:US
Mailing Address - Phone:425-922-1866
Mailing Address - Fax:
Practice Address - Street 1:1101 YAKIMA AVE # C214
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4831
Practice Address - Country:US
Practice Address - Phone:253-680-7319
Practice Address - Fax:253-680-7048
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA984237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA984OtherWASHINGTON STATE AUDIOLOGY LICENSE