Provider Demographics
NPI:1124745666
Name:HORN, JANE ENRIETTO (AUD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ENRIETTO
Last Name:HORN
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 1:22116 NE 27TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6427
Mailing Address - Country:US
Mailing Address - Phone:425-394-9988
Mailing Address - Fax:
Practice Address - Street 1:22116 NE 27TH PL
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-6427
Practice Address - Country:US
Practice Address - Phone:425-996-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61364274231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist