Healthcare Provider Details

I. General information

NPI: 1184052128
Provider Name (Legal Business Name): STEFANIE DENNEY HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 ENSIGN RD NE M-1
OLYMPIA WA
98506-5065
US

IV. Provider business mailing address

3525 ENSIGN RD NE M-1
OLYMPIA WA
98506-5065
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9733
  • Fax: 360-493-1943
Mailing address:
  • Phone: 360-491-9733
  • Fax: 360-493-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA60365216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: