Healthcare Provider Details

I. General information

NPI: 1720315492
Provider Name (Legal Business Name): SANDRA L HARSHAW-IRVIN HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA L HARSHAW HAD

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 1ST AVENUE NORTH
GREAT FALLS MT
59401
US

IV. Provider business mailing address

8800 SE SUNNYSIDE ROAD SUITE 300-N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-7269
  • Fax: 406-452-5145
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number238
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: