Healthcare Provider Details

I. General information

NPI: 1376079715
Provider Name (Legal Business Name): PACIFIC NORTHWEST HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 N DIVISION ST SUITE B
SPOKANE WA
99202-1811
US

IV. Provider business mailing address

1402 N DIVISION ST SUITE B
SPOKANE WA
99202-1811
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-7078
  • Fax: 509-327-3404
Mailing address:
  • Phone: 509-327-7078
  • Fax: 509-327-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 60648139
License Number StateWA

VIII. Authorized Official

Name: MR. TREVOR LEVI JENSEN
Title or Position: OWNER
Credential:
Phone: 509-327-7078