Healthcare Provider Details

I. General information

NPI: 1053004986
Provider Name (Legal Business Name): ELIZABETH LAWRY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 SE ORIENT DR
GRESHAM OR
97080-8847
US

IV. Provider business mailing address

7927 SE ORIENT DR
GRESHAM OR
97080-8847
US

V. Phone/Fax

Practice location:
  • Phone: 503-603-0481
  • Fax: 503-663-0480
Mailing address:
  • Phone: 503-603-0481
  • Fax: 503-663-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16831
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: