Basic Information
| Provider Information | |||||||||
| NPI: | 1417193970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHIPPLE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 350 | ||||||||
| Address2: | |||||||||
| City: | MAPLE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980380350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253580956 | ||||||||
| FaxNumber: | 8774816931 | ||||||||
| Practice Location | |||||||||
| Address1: | 3726 BROADWAY | ||||||||
| Address2: | STE 107 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252595066 | ||||||||
| FaxNumber: | 4252524327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2009 | ||||||||
| LastUpdateDate: | 09/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA00002237 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2012890 | 05 | WA | MEDICAID |