Provider Demographics
NPI:1992944474
Name:SUZUKI, MISAKO (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MISAKO
Middle Name:
Last Name:SUZUKI
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 1:7000 SW HAMPTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8317
Mailing Address - Country:US
Mailing Address - Phone:503-925-7000
Mailing Address - Fax:503-825-7000
Practice Address - Street 1:7000 SW HAMPTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8317
Practice Address - Country:US
Practice Address - Phone:503-925-4507
Practice Address - Fax:503-825-7000
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist