Provider Demographics
NPI:1578972469
Name:BRANDSEN, KARL
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:BRANDSEN
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 1:4340 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3014
Mailing Address - Country:US
Mailing Address - Phone:503-597-3020
Mailing Address - Fax:503-597-3023
Practice Address - Street 1:4340 SW 110TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3014
Practice Address - Country:US
Practice Address - Phone:503-597-3020
Practice Address - Fax:503-597-3023
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-527301237700000X
WAHA 00002758237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist