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General NPI Number Information
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NPI Number | 1780827360
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Entity Type | Organization
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Legal Business Name | OREGON TINNITUS & HYPERACUSIS TREATMENT CENTER INC.
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 1827 NE 44TH AVE SUITE 130
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City | PORTLAND
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State | OR
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Zip | 97213-1443
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Country | US
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Telephone | 503-234-1221
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Fax | 503-234-4227
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Provider Business Mailing Address
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Address Line | 1827 NE 44TH AVE SUITE 130
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City | PORTLAND
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State | OR
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Zip | 97213-1443
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Country | US
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Telephone | 503-234-1221
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Fax | 503-234-4227
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. MARSHA ANN JOHNSON
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Credential | AUD
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Telephone | 503-234-1221
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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 | 21856
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License Number State | OR
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