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NPI Code Detail

MEDICARE: MS. CHRISTINE JANE MOULTON M.S., CCC-A

MEDICARE: MS. CHRISTINE JANE MOULTON M.S., 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
1237600000XAudiologist-Hearing Aid Fitter20586OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22432417000OTHERFEDERAL WORKERS COMP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40054627OTHERWAWA WORKERS COMP

General Provider Information

NPI Number : 1720118151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE JANE MOULTON M.S., CCC-A
Provider Business Mailing Address
First Line : 1939 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1535
Country : US
Telephone Number : 503-233-6141
Fax Number : 503-233-2889
Provider Business Practice Location Address
First Line : 1939 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1535
Country : US
Telephone Number : 503-233-6141
Fax Number : 503-233-2889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/09/2007

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