Provider Demographics
NPI:1346842721
Name:DE GOEDE, TOBIANNE SARA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TOBIANNE
Middle Name:SARA
Last Name:DE GOEDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TOBI
Other - Middle Name:SARA
Other - Last Name:DE GOEDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2032 NE LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5339
Mailing Address - Country:US
Mailing Address - Phone:206-356-3379
Mailing Address - Fax:
Practice Address - Street 1:2032 NE LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5339
Practice Address - Country:US
Practice Address - Phone:206-356-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016198235Z00000X
OR06918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty