Provider Demographics
NPI:1932823978
Name:CANTY, SHEILA ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ROSE
Last Name:CANTY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 SE 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4704
Mailing Address - Country:US
Mailing Address - Phone:541-292-3608
Mailing Address - Fax:
Practice Address - Street 1:1610 SE GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5615
Practice Address - Country:US
Practice Address - Phone:503-927-3598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist