Healthcare Provider Details

I. General information

NPI: 1114108933
Provider Name (Legal Business Name): PACIFIC AUDIOLOGY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 NE BROADWAY ST
PORTLAND OR
97232-1821
US

IV. Provider business mailing address

3502 NE BROADWAY ST
PORTLAND OR
97232-1821
US

V. Phone/Fax

Practice location:
  • Phone: 503-284-1906
  • Fax: 503-546-0894
Mailing address:
  • Phone: 503-284-1906
  • Fax: 503-546-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: ALLISON ELIZABETH BRADLEY
Title or Position: OWNER
Credential:
Phone: 503-284-1906