Provider Demographics
NPI:1710585963
Name:BEECH STREET SPEECH AND LANGUAGE LLC
Entity Type:Organization
Organization Name:BEECH STREET SPEECH AND LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-927-3598
Mailing Address - Street 1:5724 NE BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3257
Mailing Address - Country:US
Mailing Address - Phone:503-927-3598
Mailing Address - Fax:971-200-5761
Practice Address - Street 1:1610 SE GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5615
Practice Address - Country:US
Practice Address - Phone:503-927-3598
Practice Address - Fax:971-200-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty