Provider Demographics
NPI:1699147660
Name:COUGAR HEARING TECHNOLOGY, INC.
Entity type:Organization
Organization Name:COUGAR HEARING TECHNOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDICT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:253-858-3277
Mailing Address - Street 1:3212 50TH STREET CT NW
Mailing Address - Street 2:STE. 100
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3212 50TH STREET CT NW
Practice Address - Street 2:STE. 100
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8527
Practice Address - Country:US
Practice Address - Phone:253-858-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60282050231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty