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General NPI Number Information
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NPI Number | 1013068865
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Entity Type | Individual
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Provider Name | CYNTHIA HERZOG M.S.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 921 NW 18TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-2324
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Country | US
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Telephone | 503-227-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 1926 W BURNSIDE ST UNIT 1602
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City | PORTLAND
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State | OR
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Zip | 97209-2066
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Country | US
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Telephone | 360-713-8818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 22540
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License Number State | OR
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