Healthcare Provider Details

I. General information

NPI: 1194193292
Provider Name (Legal Business Name): PENINSULA HEARING TECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 50TH STREET CT NW STE 100
GIG HARBOR WA
98335-8527
US

IV. Provider business mailing address

3212 50TH STREET CT NW STE 100
GIG HARBOR WA
98335-8527
US

V. Phone/Fax

Practice location:
  • Phone: 253-858-3277
  • Fax:
Mailing address:
  • Phone: 253-858-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD60282050
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberLD60282050
License Number StateWA

VIII. Authorized Official

Name: DR. KEITH D CONDICT
Title or Position: PRESIDENT/AUDIOLOGIST
Credential: AUD
Phone: 903-816-2836