MEDICARE: HAPPY ACORN LEARNING LLC

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	12566	OR

General Provider Information

NPI Number	:	1326582115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY ACORN LEARNING LLC

Provider Business Mailing Address
First Line	:	1904 SE 48TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-3220
Country	:	US
Telephone Number	:	503-577-0975
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 NE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1911
Country	:	US
Telephone Number	:	503-577-0975
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	MS. AMANDA WILLIAMS CORNELIUS
Credential	:
Telephone Number	:	503-577-0975

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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Directions to “HAPPY ACORN LEARNING LLC ” Practice Location

Language	Start Address	Practice Location

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