Provider Demographics
NPI:1093420291
Name:UPLIFT REHAB AND WELLNESS
Entity Type:Organization
Organization Name:UPLIFT REHAB AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENANCIO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:971-312-4409
Mailing Address - Street 1:3912 NE HAYES ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3912 NE HAYES ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9871
Practice Address - Country:US
Practice Address - Phone:971-312-4409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty