Healthcare Provider Details

I. General information

NPI: 1609109156
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 W 7800 S
WEST JORDAN UT
84088-4017
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-3277
  • Fax: 503-465-4768
Mailing address:
  • Phone: 830-275-4216
  • Fax: 512-858-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

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