Individual
LISA K EXLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
2305 NE WASCO ST, PORTLAND, OR 97232-1643
(706) 294-6356
Mailing address
2305 NE WASCO ST, PORTLAND, OR 97232-1643
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12850
OR
Other
Enumeration date
08/13/2007
Last updated
08/13/2007
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