Provider Demographics
NPI:1336476696
Name:GIBSON, NORM
Entity Type:Individual
Prefix:
First Name:NORM
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1535
Mailing Address - Country:US
Mailing Address - Phone:503-233-6141
Mailing Address - Fax:503-233-2889
Practice Address - Street 1:3066 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1396
Practice Address - Country:US
Practice Address - Phone:503-315-2055
Practice Address - Fax:503-315-2057
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10130630237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist