Provider Demographics
NPI:1215188065
Name:SOUTHERN OREGON AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:SOUTHERN OREGON AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-772-4484
Mailing Address - Street 1:45 HAWTHORNE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7166
Mailing Address - Country:US
Mailing Address - Phone:541-772-4484
Mailing Address - Fax:541-772-4494
Practice Address - Street 1:45 HAWTHORNE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7166
Practice Address - Country:US
Practice Address - Phone:541-772-4484
Practice Address - Fax:541-772-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty