Provider Demographics
NPI:1295998268
Name:GEORGE, CARA LISETTE (MS CCCSLP)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:LISETTE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N DIXON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1804
Mailing Address - Country:US
Mailing Address - Phone:503-916-2000
Mailing Address - Fax:
Practice Address - Street 1:5232 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-575-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist