Provider Demographics
NPI:1285924894
Name:PHOENIX HEARING
Entity type:Organization
Organization Name:PHOENIX HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:NBC/HIS
Authorized Official - Phone:360-433-8136
Mailing Address - Street 1:6400 NE HIGHWAY 99
Mailing Address - Street 2:#G167
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8748
Mailing Address - Country:US
Mailing Address - Phone:360-433-8136
Mailing Address - Fax:360-567-0620
Practice Address - Street 1:2402 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3229
Practice Address - Country:US
Practice Address - Phone:360-433-8136
Practice Address - Fax:360-567-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA3375237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty