Healthcare Provider Details

I. General information

NPI: 1679488316
Provider Name (Legal Business Name): TIFFANY LE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17704 JEAN WAY STE 101
LAKE OSWEGO OR
97035-5584
US

IV. Provider business mailing address

17704 JEAN WAY STE 101
LAKE OSWEGO OR
97035-5584
US

V. Phone/Fax

Practice location:
  • Phone: 503-699-0370
  • Fax:
Mailing address:
  • Phone: 503-699-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number31173
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: