Healthcare Provider Details

I. General information

NPI: 1861616575
Provider Name (Legal Business Name): LAURIE L JUNKER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PENN CENTER BOULEVARD SUITE 520
PITTSBURGH PA
15235
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD SUITE 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 412-823-8251
  • Fax: 412-823-8258
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000880-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000880L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: