Provider Demographics
NPI:1831943240
Name:DIFAZIO, MAGDALENA MARIE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:MARIE
Last Name:DIFAZIO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:MARIE WHITWORTH
Other - Last Name:DIFAZIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13455 SE 97TH AVE
Mailing Address - Street 2:ATTN: MAGGIE DIFAZIO, EI/ECSE DEPT
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-675-4000
Mailing Address - Fax:
Practice Address - Street 1:13455 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8662
Practice Address - Country:US
Practice Address - Phone:503-675-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist