Basic Information
| Provider Information | |||||||||
| NPI: | 1720315492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARSHAW-IRVIN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
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| Credential: | HAD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARSHAW | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | HAD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE ROAD | ||||||||
| Address2: | SUITE 300-N | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812862999 | ||||||||
| FaxNumber: | 5126074893 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 1ST AVENUE NORTH | ||||||||
| Address2: | |||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067277269 | ||||||||
| FaxNumber: | 4064525145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | MT | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | 238 | MT | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.