Healthcare Provider Details

I. General information

NPI: 1013217082
Provider Name (Legal Business Name): TODD E WILLIAMS M.A., HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NW 167TH PL 203
BEAVERTON OR
97006-4803
US

IV. Provider business mailing address

1960 NW 167TH PL 203
BEAVERTON OR
97006-4803
US

V. Phone/Fax

Practice location:
  • Phone: 503-924-7430
  • Fax:
Mailing address:
  • Phone: 503-924-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHASP10133032
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: