Basic Information
| Provider Information | |||||||||
| NPI: | 1114100641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 N 1ST ST STE 107 | ||||||||
| Address2: | |||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978381843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415674063 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 405 N 1ST ST STE 107 | ||||||||
| Address2: | |||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978381843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415674063 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-278859 | OR | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 268797 | 01 | OR | OREGON WELFARE | OTHER |