Basic Information
| Provider Information | |||||||||
| NPI: | 1841615721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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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: | 1901 S UNION AVE | ||||||||
| Address2: | STE. B-2001 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532723090 | ||||||||
| FaxNumber: | 2536271415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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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 | 231H00000X | LD60410773 | WA | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | LD 60410773 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 2039195 | 05 | WA | MEDICAID | 500676779 | 05 | OR | MEDICAID |