Provider Demographics
NPI:1356767149
Name:FIRESTONE, MARGARET JANE (SLP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:JANE
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:M
Other - Middle Name:JANE
Other - Last Name:FIRESTONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:61198 HILMER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2326
Mailing Address - Country:US
Mailing Address - Phone:541-241-4217
Mailing Address - Fax:541-306-4552
Practice Address - Street 1:61198 HILMER CREEK DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2326
Practice Address - Country:US
Practice Address - Phone:541-241-4217
Practice Address - Fax:544-130-6455
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR012058235Z00000X
OR12058261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech