MEDICARE: BARBARA C STREET M.A., CCC-A

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	20555	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024203001	OTHER	OR	REGENCE BLUE CROSS/BLUE S

General Provider Information

NPI Number	:	1619970282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA C STREET M.A., CCC-A

Provider Business Mailing Address
First Line	:	184 CLEAR CREEK DR STE 1
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1977
Country	:	US
Telephone Number	:	541-201-3201
Fax Number	:	541-201-3202

Provider Business Practice Location Address
First Line	:	184 CLEAR CREEK DR STE 1
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1977
Country	:	US
Telephone Number	:	541-201-3201
Fax Number	:	541-201-3202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/28/2009

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Directions to “ BARBARA C STREET M.A., CCC-A” Practice Location

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