Healthcare Provider Details

I. General information

NPI: 1356909121
Provider Name (Legal Business Name): JENNA LEIGH SPEGELE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LILLY RD NE STE 202
OLYMPIA WA
98506-7400
US

IV. Provider business mailing address

10302 20TH ST E APT B205
EDGEWOOD WA
98372-1437
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-6314
  • Fax:
Mailing address:
  • Phone: 317-753-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: