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General NPI Number Information
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NPI Number | 1649804048
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Entity Type | Individual
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Provider Name | GAYLA ANN IWATA-REUYL PHD
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Gender | Female
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 24900 SE STARK ST STE 106
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City | GRESHAM
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State | OR
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Zip | 97030-3381
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Country | US
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Telephone | 503-674-1123
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Fax | 503-674-1197
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Provider Business Mailing Address
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Address Line | 24900 SE STARK ST STE 106
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City | GRESHAM
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State | OR
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Zip | 97030-3381
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Country | US
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Telephone | 503-674-1123
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Fax | 503-674-1197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 011723
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License Number State | OR
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