MEDICARE: ROSE BUD SPEECH THERAPY

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

General Provider Information

NPI Number	:	1659949717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE BUD SPEECH THERAPY

Provider Business Mailing Address
First Line	:	4950 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	917-509-1920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	917-509-1920
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CASSANDRA SCHNELLER
Credential	:	CCC-SLP
Telephone Number	:	917-509-1920

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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Directions to “ROSE BUD SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

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