Provider Demographics
NPI:1558592774
Name:SUZUKI SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:SUZUKI SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUZUKI
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:503-756-1708
Mailing Address - Street 1:9450 SW COMMERCE CIR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8855
Mailing Address - Country:US
Mailing Address - Phone:503-756-1708
Mailing Address - Fax:503-715-0573
Practice Address - Street 1:9450 SW COMMERCE CIR
Practice Address - Street 2:SUITE 305
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8855
Practice Address - Country:US
Practice Address - Phone:503-756-1708
Practice Address - Fax:503-715-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13193305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization