Individual
MR. SHIVAPRAKASH SHIVANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(626) 283-0101
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(626) 283-0101
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17676
CA
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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