Provider Demographics
NPI:1649510769
Name:DVORTCSAK SPEECH AND LANGUAGE SERVICES
Entity type:Organization
Organization Name:DVORTCSAK SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORTCSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:503-887-1130
Mailing Address - Street 1:818 SW 3RD AVE # 68
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2405
Mailing Address - Country:US
Mailing Address - Phone:503-887-1130
Mailing Address - Fax:
Practice Address - Street 1:2476 NW KEARNEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3018
Practice Address - Country:US
Practice Address - Phone:503-887-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty