Provider Demographics
NPI:1871833616
Name:CLOSE, JOANNA HARTMAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HARTMAN
Last Name:CLOSE
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 1:7255 SW 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1344
Mailing Address - Country:US
Mailing Address - Phone:253-732-0719
Mailing Address - Fax:
Practice Address - Street 1:7255 SW 54TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1344
Practice Address - Country:US
Practice Address - Phone:253-732-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist