Provider Demographics
NPI:1831322114
Name:REZNIC, EMANUELA (MA-SLP)
Entity Type:Individual
Prefix:
First Name:EMANUELA
Middle Name:
Last Name:REZNIC
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:REZNIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA-SLP
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:503-413-4048
Mailing Address - Fax:503-413-2910
Practice Address - Street 1:2121 NE 139TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:360-487-1777
Practice Address - Fax:360-487-1779
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60104647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicaid
WALL60104647OtherWA PT LICENSE
WAPENDINGMedicaid