Provider Demographics
NPI:1104915180
Name:MYHRE, LINDA LOU (HIS)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:MYHRE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LOU
Other - Last Name:MOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 S UNION AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1959
Mailing Address - Country:US
Mailing Address - Phone:253-759-3555
Mailing Address - Fax:253-759-2988
Practice Address - Street 1:2845 NW KITSAP PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9447
Practice Address - Country:US
Practice Address - Phone:360-692-7056
Practice Address - Fax:253-759-2988
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00002378237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058280Medicaid
WA600383602OtherFEDERAL L&I
WA0339985OtherWA L&I
WA2044472Medicaid
WA0204149OtherL&I