Individual
MS. SUZANNE JENSEN NICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
8733 N ENDICOTT AVE, PORTLAND, OR 97217-7137
(503) 515-9083
Mailing address
8733 N ENDICOTT AVE, PORTLAND, OR 97217-7137
(503) 515-9083
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11758
OR
235Z00000X
Speech-Language Pathologist
LL00004103
WA
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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