NPI 1184186447 · live from the CMS NPI Registry
Jaclyn Renee Derosso, AuD.
Audiologist in Reseda, CA. National Provider Identifier 1184186447, active.
NPI record
| NPI | 1184186447 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Audiologist 231H00000X |
| Practice location | 18040 Sherman Way, Reseda, CA 91335 |
| Practice phone | 503-997-4669 |
| Mailing address | 5309 Sw Multnomah Blvd, Portland, OR 97219 |
| Enumerated | April 4, 2019 |
| Last updated | October 13, 2020 |
| Sole proprietor | No |
| Other names | Jaclyn Paulson |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Audiologist primary | 231H00000X | 30928 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.