Healthcare Provider Details

I. General information

NPI: 1003009325
Provider Name (Legal Business Name): AUDIOLOGY CONSULTANTS OF SOUTHERN OREGON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 W HARVARD AVE
ROSEBURG OR
97470-2838
US

IV. Provider business mailing address

1367 W HARVARD AVE
ROSEBURG OR
97470-2838
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-8868
  • Fax: 541-672-1142
Mailing address:
  • Phone: 541-672-8868
  • Fax: 541-672-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22652
License Number StateOR

VIII. Authorized Official

Name: CELIA GALLEGOS
Title or Position: BILLING ASSOCIATE
Credential:
Phone: 541-672-8868