MEDICARE: CHRISTINA MARIE SLUSARCZYK CCC-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	16846	OR

General Provider Information

NPI Number	:	1578214573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE SLUSARCZYK CCC-SLP

Provider Business Mailing Address
First Line	:	6850 SW 26TH AVE APT 50
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-1962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 SE HOLGATE BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3658
Country	:	US
Telephone Number	:	503-235-6551
Fax Number	:

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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Directions to “ CHRISTINA MARIE SLUSARCZYK CCC-SLP” Practice Location

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