Provider Demographics
NPI:1619970282
Name:STREET, BARBARA C (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:STREET
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CLEAR CREEK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1977
Mailing Address - Country:US
Mailing Address - Phone:541-201-3201
Mailing Address - Fax:541-201-3202
Practice Address - Street 1:184 CLEAR CREEK DR STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1977
Practice Address - Country:US
Practice Address - Phone:541-201-3201
Practice Address - Fax:541-201-3202
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20555231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024203001OtherREGENCE BLUE CROSS/BLUE S
OR112490Medicare PIN
OR024203001OtherREGENCE BLUE CROSS/BLUE S
OR112491Medicare PIN