Provider Demographics
NPI:1891489290
Name:ENVORO, MANDI LYNN (CF-SLP)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:LYNN
Last Name:ENVORO
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:LYNN
Other - Last Name:MAYBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3869 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2049
Mailing Address - Country:US
Mailing Address - Phone:503-946-5375
Mailing Address - Fax:
Practice Address - Street 1:3869 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2049
Practice Address - Country:US
Practice Address - Phone:503-946-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist