Doctor Name: | CHERYL ANSELMO |
NPI Number: | 1023342359 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 05403 |
Business Practice Address: | 707 Sw Gaines St Child Development & Rehab. Ctr.--portland Portland, OR - 972392901 |
Business Phone Number: | 5033460640 |
Business Fax Number: | |
Mailing Address: | 707 Sw Gaines St, Child Development & Rehab. Ctr.--portland PORTLAND |
State: | OR |
Postal Code: | 972392901 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/18/2009 |
NPI Last Update Date: | 10/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 05403 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |