Provider Demographics
NPI:1235656265
Name:TAUZIN, JACOB PAUL (HIS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:TAUZIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 SE POWELL BLVD
Mailing Address - Street 2:STE B #185
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3105
Mailing Address - Country:US
Mailing Address - Phone:971-266-3394
Mailing Address - Fax:
Practice Address - Street 1:5455 SE 91ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4603
Practice Address - Country:US
Practice Address - Phone:971-266-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP10154799237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist