Individual
ALEXANDRIA VIDALON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
15630 BOONES FERRY RD STE 6, LAKE OSWEGO, OR 97035-3455
(971) 346-0355
Mailing address
11143 NE SCHUYLER ST, PORTLAND, OR 97220-1941
(954) 478-9277
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015886
OR
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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