MEDICARE: PACIFIC AUDIOLOGY CLINIC, LLC

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1114108933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC AUDIOLOGY CLINIC, LLC

Provider Business Mailing Address
First Line	:	3502 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1821
Country	:	US
Telephone Number	:	503-284-1906
Fax Number	:	503-546-0894

Provider Business Practice Location Address
First Line	:	3502 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1821
Country	:	US
Telephone Number	:	503-284-1906
Fax Number	:	503-546-0894

Authorized Official
Title or Position	:	OWNER
Name	:	ALLISON ELIZABETH BRADLEY
Credential	:
Telephone Number	:	503-284-1906

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	08/01/2025

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