Healthcare Provider Details

I. General information

NPI: 1598235608
Provider Name (Legal Business Name): GRIFFIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 SW BEAVERTON HILLSDALE HWY STE 115
BEAVERTON OR
97005-3228
US

IV. Provider business mailing address

9955 SW BEAVERTON HILLSDALE HWY STE 115
BEAVERTON OR
97005-3228
US

V. Phone/Fax

Practice location:
  • Phone: 602-363-0622
  • Fax:
Mailing address:
  • Phone: 503-567-2231
  • Fax: 888-895-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM ATWILL
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 503-567-2231