Provider Demographics
NPI:1497172837
Name:DOUGLASS, ANDREW WAINWRIGHT (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WAINWRIGHT
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23310
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0427
Mailing Address - Country:US
Mailing Address - Phone:541-485-8521
Mailing Address - Fax:541-485-6159
Practice Address - Street 1:6044 ORCHID LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-8579
Practice Address - Country:US
Practice Address - Phone:541-275-0222
Practice Address - Fax:541-359-4339
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist