Healthcare Provider Details

I. General information

NPI: 1033072186
Provider Name (Legal Business Name): TESSA ISAAC AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S BOND AVE STE 173
PORTLAND OR
97239-4730
US

IV. Provider business mailing address

3550 S BOND AVE STE 173
PORTLAND OR
97239-4730
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-2555
  • Fax:
Mailing address:
  • Phone: 503-418-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number31127
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: