Provider Demographics
NPI:1336457308
Name:PALENSKY, MICHAEL (MA, FAAA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PALENSKY
Suffix:
Gender:M
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NW 167TH PL
Mailing Address - Street 2:STE. 203
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4803
Mailing Address - Country:US
Mailing Address - Phone:503-924-7430
Mailing Address - Fax:503-924-7432
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:STE. 203
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4803
Practice Address - Country:US
Practice Address - Phone:503-924-7430
Practice Address - Fax:503-924-7432
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22376237600000X
WALD 00002711237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter