Provider Demographics
NPI:1912111980
Name:AUDIOLOGY ASSOCIATES OF SOUTHERN OREGON, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF SOUTHERN OREGON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:541-474-4694
Mailing Address - Street 1:1665 WILLIAMS HWY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-474-4694
Mailing Address - Fax:
Practice Address - Street 1:1665 WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-474-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20545231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty