Provider Demographics
NPI:1427800192
Name:DOUGLAS, IRIS MAASE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:MAASE
Last Name:DOUGLAS
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 1:235 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5013
Mailing Address - Country:US
Mailing Address - Phone:503-791-2681
Mailing Address - Fax:
Practice Address - Street 1:785 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5947
Practice Address - Country:US
Practice Address - Phone:503-333-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist