Provider Demographics
NPI:1295193779
Name:BEAVER, WILLIAM (HIS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BEAVER
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 1:8625 SW CASCADE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8625 SW CASCADE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7121
Practice Address - Country:US
Practice Address - Phone:503-641-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10160352237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist