Individual
STORMY M IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Mailing address
1890 WAITE ST STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15021
OR
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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