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General NPI Number Information
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NPI Number | 1285121194
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Entity Type | Organization
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Legal Business Name | PATHWAY SPEECH THERAPY LLC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2035 SE WASHINGTON ST
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City | MILWAUKIE
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State | OR
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Zip | 97222-7612
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Country | US
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Telephone | 503-654-4959
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Fax | 503-437-9454
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Provider Business Mailing Address
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Address Line | 2035 SE WASHINGTON ST
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City | MILWAUKIE
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State | OR
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Zip | 97222-7612
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Country | US
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Telephone | 503-654-4959
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Fax | 503-437-9454
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Authorized Official
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Title or Position | OWNER
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Name | ELLECIA GRACE DECOUTEAU
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Credential |
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Telephone | 503-654-4959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 15632
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License Number State | OR
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