Healthcare Provider Details

I. General information

NPI: 1598373094
Provider Name (Legal Business Name): ANYWHERE SPEECH & LANGUAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NE SCOTT AVE
GRESHAM OR
97030-6147
US

IV. Provider business mailing address

2149 CASCADE AVE UNIT 422
HOOD RIVER OR
97031-1087
US

V. Phone/Fax

Practice location:
  • Phone: 503-512-0825
  • Fax:
Mailing address:
  • Phone: 503-512-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARA LACEY-MOREY
Title or Position: ADMINISTRATOR
Credential: SLP
Phone: 503-512-0825