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General NPI Number Information
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NPI Number | 1205120631
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Entity Type | Organization
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Legal Business Name | NORTHLAND HEARING CENTERS, INC.
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 2915 10TH ST. EAST
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City | GLENCOE
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State | MN
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Zip | 55336-3325
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Country | US
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Telephone | 320-864-6106
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Fax |
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Provider Business Mailing Address
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Address Line | 8800 SE SUNNYSIDE RD. STE. 300-N
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City | CLACKAMAS
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State | OR
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Zip | 97015-5738
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Country | US
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Telephone | 503-659-5115
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY LONGTAIN
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Credential |
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Telephone | 503-659-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 7479
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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