Healthcare Provider Details

I. General information

NPI: 1518830355
Provider Name (Legal Business Name): MIRIAM HUTCHINS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E HENRY RD
NEWBERG OR
97132-9100
US

IV. Provider business mailing address

715 E HENRY RD
NEWBERG OR
97132-9100
US

V. Phone/Fax

Practice location:
  • Phone: 360-508-8040
  • Fax:
Mailing address:
  • Phone: 360-508-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17578
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: