MEDICARE: JO KOENIG HALL CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	LD00001007	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9713KO	OTHER	WA	REGENCE BS RIDER #
3	0195901	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1164422028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO KOENIG HALL CCC-A

Provider Business Mailing Address
First Line	:	1135 116TH AVE NE
Second Line	:	SUITE 400
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	206-987-5770
Fax Number	:	206-987-5779

Provider Business Practice Location Address
First Line	:	1135 116TH AVE NE
Second Line	:	SUITE 400
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	206-987-5770
Fax Number	:	206-987-5779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/19/2009

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Directions to “ JO KOENIG HALL CCC-A” Practice Location

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