=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124927082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARTH AND SKY SPEECH THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3810 SE DIVISION ST STE B
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97202-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-449-6294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1839 SE 36TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-310-5536
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | SHANNON WESTBY
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 661-310-5536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------