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General NPI Number Information
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NPI Number | 1447357801
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Entity Type | Individual
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Provider Name | LAURA G. POLICH PH.D., CCC-A & SLP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 825 NE 20TH AVE SUITE 230
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City | PORTLAND
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State | OR
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Zip | 97232-2275
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Country | US
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Telephone | 503-806-1498
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Fax | 503-805-5244
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Provider Business Mailing Address
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Address Line | 825 NE 20TH AVE SUITE 230
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City | PORTLAND
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State | OR
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Zip | 97232-2275
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Country | US
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Telephone | 503-806-1498
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Fax | 503-805-5244
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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 | 22898
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | LD00004694
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License Number State | WA
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