Provider Demographics
NPI:1881046043
Name:METZGER, AUDREY MORGAN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MORGAN
Last Name:METZGER
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 1:9325 SW MAPLEWOOD DR
Mailing Address - Street 2:L127
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4934
Mailing Address - Country:US
Mailing Address - Phone:330-204-4519
Mailing Address - Fax:
Practice Address - Street 1:9325 SW MAPLEWOOD DR
Practice Address - Street 2:L127
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4934
Practice Address - Country:US
Practice Address - Phone:330-204-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 11631235Z00000X
OR015789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist