Individual provider Active NPI

Suzanne McKenzie

  • Speech-Language Pathologist
  • Portland, OR
National Provider Identifier
1063967628
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
014021 Issued in OR
Practice address
9155 SW Barnes Rd
Portland, OR 97225-6625
Phone
(503) 216-2339
NPI assigned
Aug 23, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 014021 OR Primary

Addresses

Primary practice location

9155 SW Barnes Rd
Portland, OR 97225-6625

Mailing address

9155 SW Barnes Rd
Portland, OR 97225-6625

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smckenzie373845@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170725002157 OR Practitioner - Qualified Speech Language Pathologist 4082984901 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
014021ORMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Dec 5, 2016 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 5, 2016 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

9155 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

9135 SW Barnes Rd
Ste 561
Portland, OR 97225
Phone (503) 216-2339

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

9135 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

830 NE 47th Ave
Portland, OR 97213
Phone (503) 215-2233

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1063967628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-216-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "SUZANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "014021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smckenzie373845@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9135 SW Barnes Rd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.