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NPI Code Detail

MEDICARE: BEECH STREET SPEECH AND LANGUAGE LLC

MEDICARE: BEECH STREET SPEECH AND LANGUAGE LLC
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1710585963
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEECH STREET SPEECH AND LANGUAGE LLC
Provider Business Mailing Address
First Line : 5724 NE BEECH ST
Second Line :
City : PORTLAND
State : OR
Zip : 97213-3257
Country : US
Telephone Number : 503-927-3598
Fax Number : 971-200-5761
Provider Business Practice Location Address
First Line : 1610 SE GLENWOOD ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-5615
Country : US
Telephone Number : 503-927-3598
Fax Number : 971-200-5761
Authorized Official
Title or Position : ADMINISTRATIVE DIRECTOR
Name : DEANA LARRO
Credential :
Telephone Number : 503-927-3598
Provider Enumeration Date : 10/10/2020
Last Update Date : 05/04/2023

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Directions to “BEECH STREET SPEECH AND LANGUAGE LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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