Provider Demographics
NPI:1780827360
Name:OREGON TINNITUS & HYPERACUSIS TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:OREGON TINNITUS & HYPERACUSIS TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:503-234-1221
Mailing Address - Street 1:1827 NE 44TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1443
Mailing Address - Country:US
Mailing Address - Phone:503-234-1221
Mailing Address - Fax:503-234-4227
Practice Address - Street 1:1827 NE 44TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1443
Practice Address - Country:US
Practice Address - Phone:503-234-1221
Practice Address - Fax:503-234-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21856231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty