Provider Demographics
NPI:1306119334
Name:KAY, JEANNIE (HIS)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19610 SE 1ST STREET
Mailing Address - Street 2:HEARING CENTER
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-258-6241
Mailing Address - Fax:360-258-6225
Practice Address - Street 1:19610 SE 1ST STREET
Practice Address - Street 2:HEARING CENTER
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-258-6241
Practice Address - Fax:360-258-6225
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60156693237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist