Provider Demographics
NPI:1568182186
Name:RAVANELLI, MANUELA
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:RAVANELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 EGAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2726
Mailing Address - Country:US
Mailing Address - Phone:971-340-6934
Mailing Address - Fax:
Practice Address - Street 1:11390 SE 82ND AVE STE 801
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-7637
Practice Address - Country:US
Practice Address - Phone:503-653-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10225545237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist