MEDICARE: SPEECH 4 KIDDOS LLC

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1740914431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH 4 KIDDOS LLC

Provider Business Mailing Address
First Line	:	4029 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5341
Country	:	US
Telephone Number	:	503-272-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5341
Country	:	US
Telephone Number	:	503-272-1867
Fax Number	:

Authorized Official
Title or Position	:	OWNER; CLINICIAN
Name	:	ELIZABETH MARIE PANCOAST
Credential	:	MS, CCC-SLP
Telephone Number	:	415-583-3185

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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Directions to “SPEECH 4 KIDDOS LLC ” Practice Location

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