Healthcare Provider Details

I. General information

NPI: 1780827360
Provider Name (Legal Business Name): OREGON TINNITUS & HYPERACUSIS TREATMENT CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 NE 44TH AVE SUITE 130
PORTLAND OR
97213-1443
US

IV. Provider business mailing address

1827 NE 44TH AVE SUITE 130
PORTLAND OR
97213-1443
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-1221
  • Fax: 503-234-4227
Mailing address:
  • Phone: 503-234-1221
  • Fax: 503-234-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number21856
License Number StateOR

VIII. Authorized Official

Name: DR. MARSHA ANN JOHNSON
Title or Position: CLINIC DIRECTOR
Credential: AUD
Phone: 503-234-1221