Basic Information
| Provider Information | |||||||||
| NPI: | 1588601181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFERBER | ||||||||
| FirstName: | KELLY | ||||||||
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| Credential: | AU.D, CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 MADISON ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062648689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7105 W HOOD PL | ||||||||
| Address2: | SUITE A-103 | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993366714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097355551 | ||||||||
| FaxNumber: | 5097355552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 12/31/2012 | ||||||||
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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 | 231H00000X | LD0002175 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.