MEDICARE: HEARING REHAB CENTER

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1114267101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARING REHAB CENTER

Provider Business Mailing Address
First Line	:	16699 BOONES FERRY RD
Second Line	:	#110
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035
Country	:	US
Telephone Number	:	303-984-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	16699 BOONES FERRY RD
Second Line	:	#110
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-4366
Country	:	US
Telephone Number	:	303-984-4414
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	JEFFREY WILKEN
Credential	:	AU.D.
Telephone Number	:	303-984-4414

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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