Healthcare Provider Details

I. General information

NPI: 1386854933
Provider Name (Legal Business Name): SANDRA KAY HUBBARD BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 NE 99TH ST STE 1350
VANCOUVER WA
98682-2321
US

IV. Provider business mailing address

11805 NE 99TH ST STE 1350
VANCOUVER WA
98682-2321
US

V. Phone/Fax

Practice location:
  • Phone: 206-853-2022
  • Fax:
Mailing address:
  • Phone: 206-853-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00000744
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: