Provider Demographics
NPI:1386051290
Name:VAN BUREN, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:VAN BUREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 NW MARSHALL ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2885
Mailing Address - Country:US
Mailing Address - Phone:213-422-2560
Mailing Address - Fax:
Practice Address - Street 1:390 SE CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUBLIMITY
Practice Address - State:OR
Practice Address - Zip Code:97385-9714
Practice Address - Country:US
Practice Address - Phone:800-440-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist