Healthcare Provider Details

I. General information

NPI: 1871733113
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 RIVERDALE RD
RIVERDALE UT
84405-1517
US

IV. Provider business mailing address

10570 SE WASHINGTON ST SUITE 202
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 801-334-0421
  • Fax: 503-465-4768
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIE ANN KLEIN
Title or Position: MANAGER OF THIRD-PARTY PROGRAMS
Credential:
Phone: 952-999-5529