Provider Demographics
NPI:1396805610
Name:PRILLWITZ, DAVID C (MS CCC-SP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:PRILLWITZ
Suffix:
Gender:M
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2115 SW KNOLLCREST DR
Mailing Address - Street 2:NONE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4933
Mailing Address - Country:US
Mailing Address - Phone:503-998-4450
Mailing Address - Fax:503-478-1846
Practice Address - Street 1:2115 SW KNOLLCREST DR
Practice Address - Street 2:NONE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-4933
Practice Address - Country:US
Practice Address - Phone:503-998-4450
Practice Address - Fax:503-478-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist