Basic Information
| Provider Information | |||||||||
| NPI: | 1174696272 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARING CONNECTION, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1005 W WALNUT ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094538600 | ||||||||
| FaxNumber: | 5094538616 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 W WALNUT ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094538600 | ||||||||
| FaxNumber: | 5094538616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SHEETS | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5094538600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 7122021 | 05 | WA | MEDICAID | 9054768 | 05 | WA | MEDICAID | 48169 | 01 | WA | HEARPO PROVIDER # | OTHER | 211431 | 01 | WA | STATE L&I GROUP NUMBER | OTHER | 8931873 | 05 | WA | MEDICAID | 9165HE | 01 | WA | REGENCE BLUE SHIELD GRP # | OTHER |