Provider Demographics
NPI:1902125206
Name:AMYX, JON (HAD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:AMYX
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 300-N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-659-5115
Mailing Address - Fax:503-659-5887
Practice Address - Street 1:750 THE CITY DR S
Practice Address - Street 2:STE 130
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4940
Practice Address - Country:US
Practice Address - Phone:714-776-4366
Practice Address - Fax:714-776-0899
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 3433237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist