Provider Demographics
NPI:1467126748
Name:RALSTON, BRIANNA (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 VAN WEY CIR APT C
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-9776
Mailing Address - Country:US
Mailing Address - Phone:503-713-9601
Mailing Address - Fax:
Practice Address - Street 1:1170 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6101
Practice Address - Country:US
Practice Address - Phone:541-779-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30997231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist