Healthcare Provider Details

I. General information

NPI: 1003728312
Provider Name (Legal Business Name): BRENDA GUADALUPE RODRIGUEZ AMEZCUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N BOONES FERRY RD
WOODBURN OR
97071-9601
US

IV. Provider business mailing address

1390 MERIDIAN DR
WOODBURN OR
97071-9668
US

V. Phone/Fax

Practice location:
  • Phone: 503-981-2825
  • Fax:
Mailing address:
  • Phone: 503-981-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18844
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: