Organization
SPEECH PATHOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAISE SCOLLARD (OWNER)
(503) 665-1151
Entity
Organization
Contact information
Practice address
5905 SE POWELL VALLEY RD, GRESHAM, OR 97080-1919
(503) 665-1151
(503) 669-1986
Mailing address
PO BOX 82608, PORTLAND, OR 97282-0608
(503) 665-1151
(503) 669-1986
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10394
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286005
—
OR
Enumeration date
11/17/2006
Last updated
07/02/2008
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