Healthcare Provider Details

I. General information

NPI: 1558224865
Provider Name (Legal Business Name): ARIEL MARSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

3727 NE 12TH AVE
PORTLAND OR
97212-1241
US

IV. Provider business mailing address

3727 NE 12TH AVE
PORTLAND OR
97212-1241
US

V. Phone/Fax

Practice location:
  • Phone: 971-533-2617
  • Fax:
Mailing address:
  • Phone: 971-533-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17685
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: