Healthcare Provider Details

I. General information

NPI: 1649188202
Provider Name (Legal Business Name): SUSAN GUTHRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51187 BLUE RIVER DR
VIDA OR
97488-9602
US

IV. Provider business mailing address

51187 BLUE RIVER DR
VIDA OR
97488-9602
US

V. Phone/Fax

Practice location:
  • Phone: 541-822-3338
  • Fax: 541-822-8014
Mailing address:
  • Phone: 541-822-3338
  • Fax: 541-822-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17860
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: