Provider Demographics
NPI:1821110800
Name:SEA, LOUISE MARIE (MCSD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:MARIE
Last Name:SEA
Suffix:
Gender:F
Credentials:MCSD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 NW LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6717
Mailing Address - Country:US
Mailing Address - Phone:541-389-3362
Mailing Address - Fax:
Practice Address - Street 1:145 SE SALMON AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-8427
Practice Address - Country:US
Practice Address - Phone:541-923-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10657OtherBOARD LICENSE
00756726OtherASHA MEMBER