Individual
MRS. JILL NICOLE DEYMONAZ TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
4201 NE 80TH AVE, PORTLAND, OR 97218-4211
(503) 351-8599
Mailing address
4201 NE 80TH AVE, PORTLAND, OR 97218-4211
(503) 282-2412
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12604
OR
Other
Enumeration date
03/27/2009
Last updated
03/27/2009
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