| NPI | 1417045733 |
|---|---|
| Former Name | KELLY LYNN WACKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: NE 222) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: NE 689) |
| 237600000X Audiologist-Hearing Aid Fitter (Licence: NE 076) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-06-30 |