Individual
KATHRYN GRACE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CFY-SLP
Contact information
Practice address
8643 NE BEECH ST, PORTLAND, OR 97220-5012
(503) 256-2151
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016634
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016634
OREGON STATE CONDITIONAL SLP LICENSE
OR
Enumeration date
10/24/2019
Last updated
10/24/2019
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