Healthcare Provider Details

I. General information

NPI: 1003779406
Provider Name (Legal Business Name): ISABEL ELLEN SERPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 N CENTRAL ST
PORTLAND OR
97203-6299
US

IV. Provider business mailing address

10117 SW CYNTHIA ST
BEAVERTON OR
97008-6069
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-5260
  • Fax: 503-916-2704
Mailing address:
  • Phone: 503-467-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18705
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: