Provider Demographics
NPI:1386082535
Name:DRULLINGER, LEAH PAIGE (AUD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:PAIGE
Last Name:DRULLINGER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1535
Mailing Address - Country:US
Mailing Address - Phone:503-233-6141
Mailing Address - Fax:877-432-9940
Practice Address - Street 1:1939 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1535
Practice Address - Country:US
Practice Address - Phone:503-233-6141
Practice Address - Fax:877-432-9940
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22106237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105386Medicare Oscar/Certification