Healthcare Provider Details

I. General information

NPI: 1447821905
Provider Name (Legal Business Name): ALEXIS FUNAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SW RIVER TERRACE BLVD
TIGARD OR
97224-5289
US

IV. Provider business mailing address

11713 SW WINDMILL DR
BEAVERTON OR
97008-7055
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18204
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: