Healthcare Provider Details

I. General information

NPI: 1467126748
Provider Name (Legal Business Name): BRIANNA RALSTON CHESSIK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA KATHLEEN RALSTON

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 ROYAL AVE
MEDFORD OR
97504-6101
US

IV. Provider business mailing address

1303 N EDISON PL UNIT B
KENNEWICK WA
99336-1582
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-7331
  • Fax:
Mailing address:
  • Phone: 503-713-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30997
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: