Provider Demographics
NPI:1740301563
Name:WILLOUGHBY HEARING AID CENTERS
Entity type:Organization
Organization Name:WILLOUGHBY HEARING AID CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:503-233-6141
Mailing Address - Street 1:1939 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1535
Mailing Address - Country:US
Mailing Address - Phone:503-233-6141
Mailing Address - Fax:503-233-2889
Practice Address - Street 1:1540 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4869
Practice Address - Country:US
Practice Address - Phone:541-928-2182
Practice Address - Fax:541-928-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
2432417000OtherFEDERAL WORKERS' COMP
OR212936Medicaid
2432417000OtherFEDERAL WORKERS' COMP