Provider Demographics
NPI:1043343932
Name:CERTIFIED HEARING SERVICES, PLLC
Entity type:Organization
Organization Name:CERTIFIED HEARING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-2759
Mailing Address - Street 1:403 E ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1218
Mailing Address - Country:US
Mailing Address - Phone:509-525-2759
Mailing Address - Fax:509-525-1998
Practice Address - Street 1:403 E ROSE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1218
Practice Address - Country:US
Practice Address - Phone:509-525-2759
Practice Address - Fax:509-525-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7055809Medicaid
WA9092008Medicaid
WAG8805417Medicare PIN
WAG8805413Medicare PIN
WAG8805415Medicare PIN