=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427414432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELLO CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2016
-----------------------------------------------------
Last Update Date | 01/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 SW GREENBURG RD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-517-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10300 SW GREENBURG RD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-517-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | SHARON SCHEURER
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 503-750-9724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1023768
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------