Healthcare Provider Details

I. General information

NPI: 1861772055
Provider Name (Legal Business Name): JANE ANDERSON BALLENGER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 M ST NE STE 104
AUBURN WA
98002-4503
US

IV. Provider business mailing address

721 M ST NE STE 104
AUBURN WA
98002-4503
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-3200
  • Fax: 253-939-2087
Mailing address:
  • Phone: 253-939-3200
  • Fax: 253-939-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA60222077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: