Provider Demographics
NPI:1720355225
Name:SMITH- LADORE, KELLY MAKANA (SLPA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MAKANA
Last Name:SMITH- LADORE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MAKANA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:STE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:808-242-5835
Practice Address - Street 1:425 ALEXANDER LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6524
Practice Address - Country:US
Practice Address - Phone:541-345-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist