Healthcare Provider Details

I. General information

NPI: 1033044011
Provider Name (Legal Business Name): SPARROW AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 ANDERSON AVE
COOS BAY OR
97420-1630
US

IV. Provider business mailing address

540 ANDERSON AVE
COOS BAY OR
97420-1630
US

V. Phone/Fax

Practice location:
  • Phone: 541-982-6540
  • Fax: 541-982-6541
Mailing address:
  • Phone: 541-982-6540
  • Fax: 541-982-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA RANDOLPH
Title or Position: AUDIOLOGIST
Credential:
Phone: 541-982-6540