Provider Demographics
NPI:1093160772
Name:SERPA AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:SERPA AUDIOLOGY, LLC
Other - Org Name:HEARING RESOURCES AUDIOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVONNE
Authorized Official - Middle Name:NICOL
Authorized Official - Last Name:SERPA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:503-774-3668
Mailing Address - Street 1:4311 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1315
Mailing Address - Country:US
Mailing Address - Phone:503-774-3668
Mailing Address - Fax:
Practice Address - Street 1:4311 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1315
Practice Address - Country:US
Practice Address - Phone:503-774-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22183231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty