Provider Demographics
NPI:1487979464
Name:HUBBARD, DAVID ALLEN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ENTERPRISE ROAD
Mailing Address - Street 2:MIRACLE-EAR
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095
Mailing Address - Country:US
Mailing Address - Phone:518-736-2284
Mailing Address - Fax:518-736-2285
Practice Address - Street 1:1302 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2831
Practice Address - Country:US
Practice Address - Phone:425-423-8616
Practice Address - Fax:425-353-3946
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60072872237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist