Healthcare Provider Details

I. General information

NPI: 1467374769
Provider Name (Legal Business Name): STACI BALL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13435 SE 97TH AVE
CLACKAMAS OR
97015-8662
US

IV. Provider business mailing address

4880 SW WICHITA ST
TUALATIN OR
97062-6717
US

V. Phone/Fax

Practice location:
  • Phone: 503-479-6796
  • Fax:
Mailing address:
  • Phone: 503-479-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011734
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: