MEDICARE: KERRY ANNE ROEDIGER 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	LL00003688	WA
2	235Z00000X	Speech-Language Pathologist	12293	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09138419	OTHER		ASHA CERTIFICATION - SLP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12293	OTHER	OR	OREGON LICENSE - SLP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	LL00003688	OTHER	WA	WAHINGTON LICENSE - SLP

General Provider Information

NPI Number	:	1528006368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY ANNE ROEDIGER SLP

Provider Business Mailing Address
First Line	:	1722 NW RALEIGH ST
Second Line	:	SUITE 318
City	:	PORTLAND
State	:	OR
Zip	:	97209-1753
Country	:	US
Telephone Number	:	503-224-2820
Fax Number	:	503-224-2607

Provider Business Practice Location Address
First Line	:	1722 NW RALEIGH ST
Second Line	:	SUITE 318
City	:	PORTLAND
State	:	OR
Zip	:	97209-1753
Country	:	US
Telephone Number	:	503-224-2820
Fax Number	:	503-224-2607

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/09/2007

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Directions to “ KERRY ANNE ROEDIGER SLP” Practice Location

Language	Start Address	Practice Location

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