Provider Demographics
NPI:1457531964
Name:HIXSON, LARRY T (ACA-BC-HIS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:T
Last Name:HIXSON
Suffix:
Gender:M
Credentials:ACA-BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:940 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4044
Practice Address - Country:US
Practice Address - Phone:706-858-0466
Practice Address - Fax:503-659-5968
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA237600000X, 237700000X
TN299237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4033913OtherBLUE CROSS BLUE SHIELD TN