Provider Demographics
NPI:1285127589
Name:BERNHISEL, SAMUEL MARK (AUD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MARK
Last Name:BERNHISEL
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 1:2005 NE LUCY BELLE ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9261
Mailing Address - Country:US
Mailing Address - Phone:503-327-9492
Mailing Address - Fax:
Practice Address - Street 1:201 9TH ST
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6039
Practice Address - Country:US
Practice Address - Phone:503-327-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR030911231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist