Provider Demographics
NPI:1487246104
Name:COMPREHENSIVE SPEECH LANGUAGE PATHOLOGY PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE SPEECH LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-274-8455
Mailing Address - Street 1:7120 NE 8TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3526
Mailing Address - Country:US
Mailing Address - Phone:574-274-8455
Mailing Address - Fax:
Practice Address - Street 1:210 W 4TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3493
Practice Address - Country:US
Practice Address - Phone:574-274-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech