Basic Information
| Provider Information | |||||||||
| NPI: | 1235116740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JADZAK | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | SPEECH THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11481 SW HALL BLVD | ||||||||
| Address2: | STE 201 THERAPEUTIC ASSOCIATES INC | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5034431402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 NW 4TH ST | ||||||||
| Address2: | STE B TAI CENTRAL OREGON REDMOND | ||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419237494 | ||||||||
| FaxNumber: | 5415049153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12305 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA5922 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | OR12305 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.