Healthcare Provider Details

I. General information

NPI: 1831851450
Provider Name (Legal Business Name): PHOEBE KIOSCHOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date: 11/21/2025
Reactivation Date: 12/08/2025

III. Provider practice location address

501 N DIXON ST
PORTLAND OR
97227-1876
US

IV. Provider business mailing address

219 S HAMILTON ST
PORTLAND OR
97239-4782
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18694
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: