Healthcare Provider Details

I. General information

NPI: 1548819212
Provider Name (Legal Business Name): JULIA KELLER HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N 35TH AVE, SUITE 100
YAKIMA WA
98902-1622
US

IV. Provider business mailing address

5301 W LINCOLN AVE
YAKIMA WA
98908
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-0933
  • Fax: 509-575-4763
Mailing address:
  • Phone: 509-367-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA60864598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: