Provider Demographics
NPI:1417383464
Name:KENYON AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:KENYON AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:541-317-1265
Mailing Address - Street 1:1625 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4046
Mailing Address - Country:US
Mailing Address - Phone:541-317-1265
Mailing Address - Fax:541-317-1273
Practice Address - Street 1:1625 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4046
Practice Address - Country:US
Practice Address - Phone:541-317-1265
Practice Address - Fax:541-317-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21288261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR064506Medicaid
OR500660066Medicaid