Healthcare Provider Details

I. General information

NPI: 1760730337
Provider Name (Legal Business Name): COLUMBIA GORGE HEARING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E 19TH ST, SUITE 1
THE DALLES OR
97058-3385
US

IV. Provider business mailing address

1815 E 19TH ST, SUITE 1
THE DALLES OR
97058-3385
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-8676
  • Fax: 541-298-7746
Mailing address:
  • Phone: 541-298-8676
  • Fax: 541-298-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23599
License Number StateOR

VIII. Authorized Official

Name: WENDY CAMERON
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-298-8676