Provider Demographics
NPI:1457702565
Name:ABDULRAHIMZI, JADE NICOLE HORTON I (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE HORTON
Last Name:ABDULRAHIMZI
Suffix:I
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:NICOLE
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7078
Mailing Address - Country:US
Mailing Address - Phone:503-894-1539
Mailing Address - Fax:
Practice Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7078
Practice Address - Country:US
Practice Address - Phone:503-894-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist