Provider Demographics
NPI:1851726319
Name:BRONSDON, DUSTIN M (AUD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:M
Last Name:BRONSDON
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 1:9532 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5041
Mailing Address - Country:US
Mailing Address - Phone:715-797-3021
Mailing Address - Fax:
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-222-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30783231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist