MEDICARE: STEFANI K COZINE M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	022594	OR
2	237600000X	Audiologist-Hearing Aid Fitter	1003982	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	198099	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1417958885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANI K COZINE M.S.

Provider Business Mailing Address
First Line	:	3600 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1106
Country	:	US
Telephone Number	:	503-331-6506
Fax Number	:	503-331-6051

Provider Business Practice Location Address
First Line	:	3600 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1106
Country	:	US
Telephone Number	:	503-331-6506
Fax Number	:	503-331-6051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/06/2009

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Directions to “ STEFANI K COZINE M.S.” Practice Location

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