Provider Demographics
NPI:1053430397
Name:LEAVITT, RON J (AUD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:J
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 I ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-1820
Mailing Address - Country:US
Mailing Address - Phone:503-838-2838
Mailing Address - Fax:
Practice Address - Street 1:975 NW SPRUCE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2297
Practice Address - Country:US
Practice Address - Phone:541-754-1377
Practice Address - Fax:541-754-9192
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20698231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter