Provider Demographics
NPI:1124474002
Name:YEGOROV, OLIYA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:OLIYA
Middle Name:
Last Name:YEGOROV
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:YEGOROV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:909 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1705
Mailing Address - Country:US
Mailing Address - Phone:503-962-1907
Mailing Address - Fax:
Practice Address - Street 1:909 SW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1705
Practice Address - Country:US
Practice Address - Phone:503-962-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist