Healthcare Provider Details

I. General information

NPI: 1740581297
Provider Name (Legal Business Name): SVETLANA GELMAN M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2010
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE LAKE RD STE 2A
MILWAUKIE OR
97222
US

IV. Provider business mailing address

2100 SE LAKE RD STE 2A
MILWAUKIE OR
97222-7759
US

V. Phone/Fax

Practice location:
  • Phone: 503-852-1375
  • Fax: 503-893-3063
Mailing address:
  • Phone: 503-852-1375
  • Fax: 503-893-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019165-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: