Provider Demographics
NPI:1588917926
Name:KITSAP AUDIOLOGY, INC.
Entity type:Organization
Organization Name:KITSAP AUDIOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-692-6650
Mailing Address - Street 1:3100 NW BUCKLIN HILL RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8358
Mailing Address - Country:US
Mailing Address - Phone:360-692-6650
Mailing Address - Fax:360-692-8581
Practice Address - Street 1:3100 NW BUCKLIN HILL RD
Practice Address - Street 2:STE 103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8358
Practice Address - Country:US
Practice Address - Phone:360-692-6650
Practice Address - Fax:360-692-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2618237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
193484300OtherACS PROVIDER NUMBER
WA0221356OtherWASHINGTON STATE LABOR & INDUSTRIES GROUP PROVIDER NUMBER