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General NPI Number Information
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NPI Number | 1467521583
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Entity Type | Organization
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Legal Business Name | AUDIOLOGY AND HEARING AID CENTER OF GRESHAM
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 752 NE BURNSIDE ST
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City | GRESHAM
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State | OR
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Zip | 97030
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Country | US
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Telephone | 503-669-7061
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Fax | 503-492-3033
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Provider Business Mailing Address
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Address Line | 752 NE BURNSIDE ST
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City | GRESHAM
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State | OR
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Zip | 97030
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Country | US
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Telephone | 503-669-7061
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Fax | 503-492-3033
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MRS. SHERI L SMITH
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Credential | MS
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Telephone | 503-669-7061
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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 | 0310108088
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License Number State | OR
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