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General NPI Number Information
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NPI Number | 1215188065
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Entity Type | Organization
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Legal Business Name | SOUTHERN OREGON AUDIOLOGY, INC.
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 45 HAWTHORNE ST SUITE 3
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City | MEDFORD
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State | OR
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Zip | 97504-7166
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Country | US
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Telephone | 541-772-4484
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Fax | 541-772-4494
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Provider Business Mailing Address
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Address Line | 45 HAWTHORNE ST SUITE 3
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City | MEDFORD
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State | OR
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Zip | 97504-7166
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Country | US
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Telephone | 541-772-4484
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Fax | 541-772-4494
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PATRICIA LYNN SEVERSON
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Credential |
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Telephone | 541-772-4484
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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 |
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License Number State | OR
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