=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386980761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY KATHLEEN JACKY AU.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2012
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 E ALDER ST STE 2
-----------------------------------------------------
City | WALLA WALLA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99362-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-876-0555
-----------------------------------------------------
Fax | 509-876-0556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 E ALDER ST STE 2
-----------------------------------------------------
City | WALLA WALLA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99362-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-876-0555
-----------------------------------------------------
Fax | 509-876-0556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | LD60285618
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | LD60285618
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------