MEDICARE: MRS. ALLYSON LYNNE GOODWYN-CRAINE SLP

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	010898	OR

General Provider Information

NPI Number	:	1235279464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLYSON LYNNE GOODWYN-CRAINE SLP

Provider Business Mailing Address
First Line	:	3707 SW ARNOLD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-9514
Country	:	US
Telephone Number	:	503-452-2413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 SW MARLOW AVE STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5102
Country	:	US
Telephone Number	:	503-228-6479
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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