Provider Demographics
NPI:1356078711
Name:DORANTES, SOFIA L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:L
Last Name:DORANTES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 SE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5811
Mailing Address - Country:US
Mailing Address - Phone:773-554-4202
Mailing Address - Fax:
Practice Address - Street 1:2900 NW VINE ST
Practice Address - Street 2:UNITS D,E,F
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-816-4747
Practice Address - Fax:541-787-4011
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist