Provider Demographics
NPI:1821377490
Name:MCLOUGHLIN, MARA WHITNEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:WHITNEY
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials: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 13638
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0638
Mailing Address - Country:US
Mailing Address - Phone:503-888-4949
Mailing Address - Fax:
Practice Address - Street 1:2905 SE GRANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5644
Practice Address - Country:US
Practice Address - Phone:503-888-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist