Individual
ALYCIA CANAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
1126 GATEWAY LOOP STE 112, SPRINGFIELD, OR 97477-7723
(541) 371-2782
(541) 804-7695
Mailing address
1126 GATEWAY LOOP STE 112, SPRINGFIELD, OR 97477-7723
(541) 371-2782
(541) 804-7695
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
15420
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500689312
—
OR
Enumeration date
06/23/2015
Last updated
10/02/2018
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