MEDICARE: ELIZABETH NESSER MS, 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	12170	OR

General Provider Information

NPI Number	:	1588628887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NESSER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3580 SE HARRISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-5878
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 SW MACADAM AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3843
Country	:	US
Telephone Number	:	503-224-1998
Fax Number	:

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/08/2007

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