Provider Demographics
NPI:1700119757
Name:THURMAN, JAY HILTON (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:HILTON
Last Name:THURMAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 NE TILLAMOOK STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1315
Mailing Address - Country:US
Mailing Address - Phone:503-774-3668
Mailing Address - Fax:503-774-7247
Practice Address - Street 1:4311 NE TILLAMOOK STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1315
Practice Address - Country:US
Practice Address - Phone:503-774-3668
Practice Address - Fax:503-774-7247
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-756055237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR195602Medicaid