Provider Demographics
NPI:1023576212
Name:SOLIDAY, SHARON (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SOLIDAY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-0623
Mailing Address - Country:US
Mailing Address - Phone:503-267-7081
Mailing Address - Fax:
Practice Address - Street 1:8130 SE 145TH CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-5384
Practice Address - Country:US
Practice Address - Phone:503-267-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist