Provider Demographics
NPI:1902625742
Name:HEDINE, SAMUEL EINAR (MS, SLP-CF)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EINAR
Last Name:HEDINE
Suffix:
Gender:M
Credentials:MS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1712
Mailing Address - Country:US
Mailing Address - Phone:503-317-3547
Mailing Address - Fax:
Practice Address - Street 1:8625 SW CASCADE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7126
Practice Address - Country:US
Practice Address - Phone:877-755-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist