| Doctor Name: | BOONE REAVIS |
| NPI Number: | 1306224480 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 25117 Sw Parkway Ave Ste D Wilsonville, OR - 970709697 |
| Business Phone Number: | 9712442040 |
| Business Fax Number: | |
| Mailing Address: | 1009 Ne 47th Ave, #12 PORTLAND |
| State: | OR |
| Postal Code: | 972132218 |
| Phone Number: | 9715700537 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2015 |
| NPI Last Update Date: | 05/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |