MEDICARE: DVORTCSAK SPEECH AND LANGUAGE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12296	OR

General Provider Information

NPI Number	:	1649510769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DVORTCSAK SPEECH AND LANGUAGE SERVICES

Provider Business Mailing Address
First Line	:	818 SW 3RD AVE # 68
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97204-2405
Country	:	US
Telephone Number	:	503-887-1130
Fax Number	:

Provider Business Practice Location Address
First Line	:	2476 NW KEARNEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3018
Country	:	US
Telephone Number	:	503-887-1130
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNA DVORTCSAK
Credential	:	MS CCC-SLP
Telephone Number	:	503-887-1130

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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Directions to “DVORTCSAK SPEECH AND LANGUAGE SERVICES ” Practice Location

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