Healthcare Provider Details

I. General information

NPI: 1730857434
Provider Name (Legal Business Name): JOEY LIM MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 19TH ST NE
SALEM OR
97301-2252
US

IV. Provider business mailing address

1132 19TH ST NE
SALEM OR
97301-2252
US

V. Phone/Fax

Practice location:
  • Phone: 715-495-3504
  • Fax:
Mailing address:
  • Phone: 715-495-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17854
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: