Provider Demographics
NPI:1851127401
Name:GRACEFUL SPEECH AND SWALLOW SOLUTIONS, LLC
Entity type:Organization
Organization Name:GRACEFUL SPEECH AND SWALLOW SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DESHKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:310-218-7912
Mailing Address - Street 1:772 NW 118TH AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5966
Mailing Address - Country:US
Mailing Address - Phone:503-597-8877
Mailing Address - Fax:
Practice Address - Street 1:772 NW 118TH AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5966
Practice Address - Country:US
Practice Address - Phone:503-597-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty