Healthcare Provider Details

I. General information

NPI: 1598505661
Provider Name (Legal Business Name): LAURA REBECCA OUSLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SE 182ND AVE
GRESHAM OR
97030-5028
US

IV. Provider business mailing address

3505 SE 182ND AVE
GRESHAM OR
97030-5028
US

V. Phone/Fax

Practice location:
  • Phone: 503-762-6180
  • Fax:
Mailing address:
  • Phone: 503-762-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17194
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: