Active NPI
Joseph Mychaylo Lake, CCC-SLP
- Speech-Language Pathologist
- Albany, OR
National Provider Identifier
1063399095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 17554
- Practice address
- 385 Timber Ridge St NE
Albany, OR 97322-7425 - Phone
- (541) 926-2118
- NPI assigned
- Aug 20, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 17554 | OR | Primary |
Addresses
Primary practice location
385 Timber Ridge St NE
Albany, OR 97322-7425
Mailing address
650 1St Ave SE # 202
Albany, OR 97321-2744
Phone (541) 981-9983
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17554 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756080000000",
"number": "1063399095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 1ST AVE SE # 202",
"city": "ALBANY",
"state": "OR",
"postal_code": "973212744",
"telephone_number": "541-981-9983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "385 TIMBER RIDGE ST NE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973227425",
"telephone_number": "541-926-2118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "JOSEPH",
"middle_name": "MYCHAYLO",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-20",
"last_updated": "2025-08-25",
"certification_date": "2025-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "17554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.