Individual
MR. MARK FREDERICK CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
1603 NE 52ND AVE, PORTLAND, OR 97213-2725
(503) 922-0768
(503) 914-5545
Mailing address
1603 NE 52ND AVE, PORTLAND, OR 97213-2725
(503) 922-0768
(503) 914-5545
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12024
OR
235Z00000X
Speech-Language Pathologist
LL00004701
WA
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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