Basic Information
| Provider Information | |||||||||
| NPI: | 1265733141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARING HEALTHCARE PROFESSIONALS OF OREGON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SONUS SF0011 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE PKWY N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554464103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632684115 | ||||||||
| FaxNumber: | 7632684430 | ||||||||
| Practice Location | |||||||||
| Address1: | 3975 MERCANTILE DR | ||||||||
| Address2: | STE 215 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970353595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036973600 | ||||||||
| FaxNumber: | 5036973555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2010 | ||||||||
| LastUpdateDate: | 02/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | DOTSON | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7632684084 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.