Provider Demographics
NPI:1316760929
Name:COLMENA CLINIC
Entity type:Organization
Organization Name:COLMENA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:DORANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:773-554-4202
Mailing Address - Street 1:7216 SE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5811
Mailing Address - Country:US
Mailing Address - Phone:773-554-4202
Mailing Address - Fax:503-961-1723
Practice Address - Street 1:7216 SE 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5811
Practice Address - Country:US
Practice Address - Phone:773-554-4202
Practice Address - Fax:503-961-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty