Healthcare Provider Details

I. General information

NPI: 1942236633
Provider Name (Legal Business Name): CENTER FOR EARLY INTERVENTION ON DEAFNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 GRAYSON ST
BERKELEY CA
94710-2642
US

IV. Provider business mailing address

1035 GRAYSON ST
BERKELEY CA
94710-2642
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-4800
  • Fax: 510-848-4801
Mailing address:
  • Phone: 510-848-4800
  • Fax: 510-848-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberHA3963
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP11949
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA3963
License Number StateCA

VIII. Authorized Official

Name: MS. CINDY DICKESON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-848-4800