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Individual

SARAH SELLEVAAG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
507 NE 47TH AVE, PORTLAND, OR 97213-2236
(503) 215-6488
Mailing address
507 NE 47TH AVE, PORTLAND, OR 97213-2236

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
13534
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13534
SPEECH-LANGUAGE PATHOLOGY LICENSE
OR
01
14062832
ASHA CERTIFICATION
OR
Enumeration date
06/02/2016
Last updated
06/02/2016
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