Individual
MIRANDA SUE VALLE-RIESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2500 NE 65TH AVE, VANCOUVER, WA 98661-6812
(360) 750-7500
Mailing address
1936 NE EMERSON ST, PORTLAND, OR 97211-5513
(360) 750-7500
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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