Provider Demographics
NPI:1629012745
Name:SALEM AUDIOLOGY CLINIC, INC
Entity Type:Organization
Organization Name:SALEM AUDIOLOGY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:FRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MS F-AAA
Authorized Official - Phone:503-588-1039
Mailing Address - Street 1:3857 WOLVERINE ST NE
Mailing Address - Street 2:STE 16C
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-4270
Mailing Address - Country:US
Mailing Address - Phone:503-588-1039
Mailing Address - Fax:503-588-1468
Practice Address - Street 1:3857 WOLVERINE ST NE
Practice Address - Street 2:STE 16C
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4270
Practice Address - Country:US
Practice Address - Phone:503-588-1039
Practice Address - Fax:503-588-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22612231H00000X
ORHAS-P-003469237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027732Medicaid
OR0000WFBYBMedicare ID - Type Unspecified