Provider Demographics
NPI:1144579434
Name:D'URSO, NANCY ROSEANN (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ROSEANN
Last Name:D'URSO
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 1:1634 BONNIEBRAE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1629
Mailing Address - Country:US
Mailing Address - Phone:503-407-4059
Mailing Address - Fax:
Practice Address - Street 1:2715 LILAC ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3526
Practice Address - Country:US
Practice Address - Phone:360-575-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA483694F235Z00000X
WA60303857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist