Provider Demographics
NPI:1083445399
Name:KRAFT, PAULA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KRAFT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 DIVISION ST STE 20
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1572
Mailing Address - Country:US
Mailing Address - Phone:503-572-1611
Mailing Address - Fax:
Practice Address - Street 1:1510 DIVISION ST STE 20
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1572
Practice Address - Country:US
Practice Address - Phone:503-572-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist