Provider Demographics
NPI:1598886111
Name:EICKELBERG, KELLI MURDOCK (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:MURDOCK
Last Name:EICKELBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 SW CIRRUS DRIVE, SUITE 32-D
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5966
Mailing Address - Country:US
Mailing Address - Phone:503-520-5030
Mailing Address - Fax:503-520-5090
Practice Address - Street 1:7701 SW CIRRUS DRIVE, SUITE 32-D
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5966
Practice Address - Country:US
Practice Address - Phone:503-520-5030
Practice Address - Fax:503-520-5090
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10960OtherOREGAON STATE LICENSE
WALL60802215OtherWA STATE LICENSE