Healthcare Provider Details

I. General information

NPI: 1881416436
Provider Name (Legal Business Name): JANE SCHNELL LEGG MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 SW 6TH ST
REDMOND OR
97756-7143
US

IV. Provider business mailing address

23025 BUTTERFIELD TRL
BEND OR
97702-9685
US

V. Phone/Fax

Practice location:
  • Phone: 541-693-5600
  • Fax:
Mailing address:
  • Phone: 541-419-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12014203
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: