Provider Demographics
NPI:1093477358
Name:WHITING, MIYKA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIYKA
Middle Name:
Last Name:WHITING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19431 ORCHARD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7129
Mailing Address - Country:US
Mailing Address - Phone:503-505-2591
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD STE 362
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6683
Practice Address - Country:US
Practice Address - Phone:503-216-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR14415087Medicaid