| Doctor Name: | MICAH SANDERS-MASSINGALE |
| NPI Number: | 1306197561 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 14073 |
| Business Practice Address: | 2811 Ne 139th St Vancouver, WA - 986862724 |
| Business Phone Number: | 3605745247 |
| Business Fax Number: | |
| Mailing Address: | 4428 Se Francis St, PORTLAND |
| State: | OR |
| Postal Code: | 972063258 |
| Phone Number: | 2174126583 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2012 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 14073 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| 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 |