Healthcare Provider Details

I. General information

NPI: 1871360958
Provider Name (Legal Business Name): CHERI DODGE CHIN CLINSCD, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 SE ORIENT DR
GRESHAM OR
97080-8847
US

IV. Provider business mailing address

13203 SE 172ND AVE SUITE 166, PMB 2068
HAPPY VALLEY OR
97086-8738
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-0481
  • Fax:
Mailing address:
  • Phone: 503-882-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12279
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: