MEDICARE: ISABEL ELLEN SERPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18705	OR

General Provider Information

NPI Number	:	1003779406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL ELLEN SERPA

Provider Business Mailing Address
First Line	:	10117 SW CYNTHIA ST
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97008-6069
Country	:	US
Telephone Number	:	503-467-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 N CENTRAL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-6299
Country	:	US
Telephone Number	:	503-916-5260
Fax Number	:	503-916-2704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ ISABEL ELLEN SERPA ” Practice Location

Language	Start Address	Practice Location

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