Healthcare Provider Details

I. General information

NPI: 1932494622
Provider Name (Legal Business Name): NORTHLAND HEARING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 COOPER STREET NW STE 102
OLYMPIA WA
98502
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-704-7900
  • Fax: 360-704-7909
Mailing address:
  • Phone: 503-659-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLD00003944
License Number StateWA

VIII. Authorized Official

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