Healthcare Provider Details

I. General information

NPI: 1023321312
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 100 S SUITE 320
LOGAN UT
84321-5810
US

IV. Provider business mailing address

10570 SE WASHINGTON ST SUITE 210
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 801-334-0421
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT NELSON
Title or Position: VP FINANCE
Credential:
Phone: 952-828-9120