Individual
MIRA E SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
2855 SE 61ST AVENUE, PORTLAND, OR 97206-1320
(503) 348-0931
Mailing address
2855 SE 61ST AVENUE, PORTLAND, OR 97206-1320
(503) 348-0931
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11905
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09121071
ASHA
—
01
—
11905
STATE LICENSE
OR
01
—
4B3VBDX2W6CCB6CWCKMF
STATE LICENSE
WA
Enumeration date
04/15/2008
Last updated
04/15/2008
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