Provider Demographics
NPI:1265001903
Name:RIZZIO, MALLORY SHARON LOPAS
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:SHARON LOPAS
Last Name:RIZZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:SHARON
Other - Last Name:LOPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6252 SW BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2633
Mailing Address - Country:US
Mailing Address - Phone:503-515-4918
Mailing Address - Fax:
Practice Address - Street 1:6252 SW BURLINGAME AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2633
Practice Address - Country:US
Practice Address - Phone:503-515-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist