Healthcare Provider Details

I. General information

NPI: 1164716304
Provider Name (Legal Business Name): KATE B JABLONSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE B WIDTFELDT AUD

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 116TH AVE NE STE 330
BELLEVUE WA
98004-4621
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-5596
  • Fax: 425-451-3248
Mailing address:
  • Phone: 763-268-4388
  • Fax: 763-268-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD60003462
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: