Active NPI
Bret Anthony Wonderlick, M.S. CCC-A
- Audiologist
- Portland, OR
National Provider Identifier
1982940169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 21957
- Practice address
- 1849 NW Kearney St
Suite 200
Portland, OR 97209-1453 - Phone
- (971) 570-5387
- NPI assigned
- Dec 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 21957 | OR | Primary |
Addresses
Primary practice location
1849 NW Kearney St
Suite 200
Portland, OR 97209-1453
Mailing address
2702 NE Bryce St
Portland, OR 97212-1638
Phone (503) 567-9392
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21957 | OR | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370995200000",
"number": "1982940169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2702 NE BRYCE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121638",
"telephone_number": "503-567-9392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1849 NW KEARNEY ST",
"address_2": "SUITE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091453",
"telephone_number": "971-570-5387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONDERLICK",
"first_name": "BRET",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "M.S. CCC-A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-17",
"last_updated": "2013-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OR",
"license": "21957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.