Healthcare Provider Details

I. General information

NPI: 1043589740
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2011
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 9TH AVENUE SUITE 100
LONGVIEW WA
98632
US

IV. Provider business mailing address

8800 SE SUNNYSIDE ROAD SUITE 300-N
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-8242
  • Fax:
Mailing address:
  • Phone: 503-659-5115
  • Fax: 503-659-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number602634408
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number602634408
License Number StateWA

VIII. Authorized Official

Name: MR. JEFFREY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-659-5115