Provider Demographics
NPI:1336389246
Name:MADORE, REBECCA ANN (SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MADORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SCHOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:3101 SE 192ND AVE STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1443
Practice Address - Country:US
Practice Address - Phone:360-553-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013266235Z00000X
WALL60134255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist