Provider Demographics
NPI:1902039464
Name:KLAMATH AUDIOLOGY
Entity Type:Organization
Organization Name:KLAMATH AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOLSTIKHINE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:541-884-6101
Mailing Address - Street 1:123 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6320
Mailing Address - Country:US
Mailing Address - Phone:541-884-6101
Mailing Address - Fax:541-882-4167
Practice Address - Street 1:123 N 4TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6320
Practice Address - Country:US
Practice Address - Phone:541-884-6101
Practice Address - Fax:541-882-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22922231H00000X
332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty