Individual
MRS. ANN GOGENOLA ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCCSLP
Contact information
Practice address
930 GARA PL, ASTORIA, OR 97103-5720
(503) 440-0802
Mailing address
930 GARA PL, ASTORIA, OR 97103-5720
(503) 440-0802
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
013096
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01024475
ASHA CERTIFICATION
—
01
—
013096
OREGON BOARD OF EXAMINERS
OR
Enumeration date
06/23/2010
Last updated
06/23/2010
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