Individual
CARISSA LYNNE CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-5293
Mailing address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-5293
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016361
OR
Other
Enumeration date
10/14/2018
Last updated
10/14/2018
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