Provider Demographics
NPI:1689174963
Name:BEADLES, JACOB MICHAEL (AUD)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:MICHAEL
Last Name:BEADLES
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25025 NE BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-8560
Mailing Address - Country:US
Mailing Address - Phone:213-278-3414
Mailing Address - Fax:
Practice Address - Street 1:9735 SW SHADY LN STE 302
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5481
Practice Address - Country:US
Practice Address - Phone:503-227-3668
Practice Address - Fax:503-227-2234
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR030904231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist