MEDICARE: NORTHLAND HEARING CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment
2	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1104066430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND HEARING CENTERS, INC

Provider Business Mailing Address
First Line	:	10570 SE WASHINGTON ST
Second Line	:	SUITE 202
City	:	PORTLAND
State	:	OR
Zip	:	97216-2846
Country	:	US
Telephone Number	:	503-257-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2818
Country	:	US
Telephone Number	:	801-463-7899
Fax Number	:	971-925-1285

Authorized Official
Title or Position	:	MANAGER OF THIRD-PARTY PROGRAMS
Name	:	KATIE ANN KLEIN
Credential	:
Telephone Number	:	952-999-5529

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	05/09/2024

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