Kathleen Stacie Theilacker, AUD

Primary specialty

AudiologistTaxonomy code 231H00000X

License

31052 Issued in OR

Practice address

9280 SE Sunnybrook Blvd Ste 300
Clackamas, OR 97015-9353

Phone

(503) 233-5548

Fax

(503) 230-1009

NPI assigned

Nov 1, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Oregon Clinic PC

  • Specialist
  • Portland, OR
  • NPI 1265417174
  Medicare reassignment Care Compare group NPD
• Eastmoreland Ear, Nose & Throat, Clinic, LLP

  • Otolaryngology/Facial Plastic Surgery Physician
  • Clackamas, OR
  • NPI 1386754398
  Medicare reassignment NPD
• The Oregon Clinic, PC

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1346105129
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1205348166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9280 SE SUNNYBROOK BLVD STE 300",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159353",
            "telephone_number": "503-233-5548",
            "fax_number": "503-230-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9280 SE SUNNYBROOK BLVD STE 300",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159353",
            "telephone_number": "503-233-5548",
            "fax_number": "503-230-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEILACKER",
        "first_name": "KATHLEEN",
        "middle_name": "STACIE",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-01",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "4382",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "31052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ioana-Maria Tepes
• Temesgen Terfassa
• Tiffany Lee Barbara Terry, HIS
• Megan Louise Thatcher, RD
• The Ripple Center LLC
• Therapeutic Associates Inc
• Caroline Keziah Thiongo
• Sean Eric Thompson, CRNA
• James G. Thornburg, D.C.
• Kathy Thurow, RRT

• Audiologist in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Audiologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.