Provider Demographics
NPI:1245342278
Name:CRANDALL, LISA MARIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIA PRZYBYLA
Other - Last Name:REMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:10180 SE SUNNYSIDE RD
Mailing Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8970
Mailing Address - Country:US
Mailing Address - Phone:503-571-3823
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:503-571-5838
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist