Provider Demographics
NPI:1639324296
Name:MAZURIK, ANN MICHELLE (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:MAZURIK
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 1:14291 SE 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8766
Mailing Address - Country:US
Mailing Address - Phone:503-558-1124
Mailing Address - Fax:
Practice Address - Street 1:14291 SE 172ND AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8766
Practice Address - Country:US
Practice Address - Phone:503-558-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist