MEDICARE: SUSAN ASHBURY

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	LL60115727	WA

General Provider Information

NPI Number	:	1538701024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ASHBURY

Provider Business Mailing Address
First Line	:	7311 N LANCASTER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5637
Country	:	US
Telephone Number	:	971-269-4769
Fax Number	:

Provider Business Practice Location Address
First Line	:	7311 N LANCASTER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5637
Country	:	US
Telephone Number	:	971-269-4769
Fax Number	:

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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Directions to “ SUSAN ASHBURY ” Practice Location

Language	Start Address	Practice Location

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