Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 231H00000X | Audiologist | | 20878 | OREGON | No |
| 2 | 237600000X | Audiologist-Hearing Aid Fitter | | 20094 | OREGON | No |
| 3 | 237600000X | Audiologist-Hearing Aid Fitter | | 20878 | OREGON | No |
| 4 | 237700000X | Hearing Instrument Specialist | | HASP038758 | OREGON | No |
| 5 | 237700000X | Hearing Instrument Specialist | | HASP812171 | OREGON | No |
| 6 | 231H00000X | Audiologist | | 20094 | OREGON | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | J1773 | OTHER | OREGON | PACIFICSOURCE |
| 2 | 800519900 | OTHER | OREGON | PREFERRED CHOICE 65 |
| 3 | 051719 | MEDICAID | OREGON | |
| 4 | =========97401A001 | OTHER | OREGON | TRICARE/TRIWEST |
| 5 | 353946700 | OTHER | OREGON | US DEPT OF LABOR |
| 6 | 014706000 | OTHER | OREGON | REGENCE BC/BS |
| 7 | R0000WCPDH | MEDICARE ID-TYPE UNSPECIFIED | OREGON | GROUP NUMBER |
| 8 | CD4334 | MEDICARE ID-TYPE UNSPECIFIED | OREGON | RAILROAD MEDICARE |
| 9 | 700053 | MEDICAID | OREGON | |
| 10 | R0000WCPDH | MEDICARE PIN | OREGON | |
