Healthcare Provider Details

I. General information

NPI: 1811927809
Provider Name (Legal Business Name): SANDRA BOOK HEFFRON M.A. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD (V-5-AUD)
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

1601 E FOURTH PLAIN BLVD (V-5-AUD)
VANCOUVER WA
98661-3753
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4061
  • Fax: 360-759-1600
Mailing address:
  • Phone: 360-696-4061
  • Fax: 360-759-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number21083
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: