Provider Demographics
NPI:1053733634
Name:OHRC SALEM LLC
Entity type:Organization
Organization Name:OHRC SALEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILKEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:360-816-2958
Mailing Address - Street 1:1560 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4310
Mailing Address - Country:US
Mailing Address - Phone:360-816-2958
Mailing Address - Fax:
Practice Address - Street 1:1560 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4310
Practice Address - Country:US
Practice Address - Phone:360-816-2958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty