Individual
JAMES DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
1204 NE 201ST AVE, FAIRVIEW, OR 97024-2499
(503) 661-7200
Mailing address
1204 NE 201ST AVE, FAIRVIEW, OR 97024-2499
(503) 661-7200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
18392
OR
Other
Enumeration date
12/04/2019
Last updated
04/07/2025
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