Individual
MS. KELLY CLARK BAWDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
7024 N DELAWARE AVE, PORTLAND, OR 97217-5702
(503) 572-5503
Mailing address
7024 N DELAWARE AVE, PORTLAND, OR 97217-5702
(503) 572-5503
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
12956
OR
235Z00000X
Speech-Language Pathologist
Primary
LL 00004702
WA
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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