Individual
SUSAN ANN FODELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
6327 SE MILWAUKIE AVE, PORTLAND, OR 97202-5418
(503) 418-2268
Mailing address
6327 SE MILWAUKIE AVE, PORTLAND, OR 97202-5418
(503) 418-2268
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
012628
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269736
—
OR
Enumeration date
06/03/2006
Last updated
07/17/2007
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