Provider Demographics
NPI:1326759598
Name:LASCHOBER, SYDNEY MARIAH (SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MARIAH
Last Name:LASCHOBER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NE HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7450
Mailing Address - Country:US
Mailing Address - Phone:503-666-1333
Mailing Address - Fax:
Practice Address - Street 1:304 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7450
Practice Address - Country:US
Practice Address - Phone:503-666-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16964OtherSTATE LICENSURE BOARD