Provider Demographics
NPI:1780850610
Name:JELLISON, NORA KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:KAY
Last Name:JELLISON
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 3528
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-3528
Mailing Address - Country:US
Mailing Address - Phone:503-670-9990
Mailing Address - Fax:
Practice Address - Street 1:10368 SW KOSO ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7598
Practice Address - Country:US
Practice Address - Phone:503-670-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist