NPIMap

Samuel Skaaland

Individual provider Active NPI Speech-Language Pathologist · Boring, OR

NPI 1083265706 · NPPES record last updated May 1, 2022

Key facts

NPI
1083265706
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
17185 (OR)
Practice address
34651 SE Kelso Rd
Boring, OR 97009-7041
Phone
(503) 668-8020
NPI assigned
Sep 24, 2019
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
14297262COMDSpeech-Language Pathologist
17185ORMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Little Peas Speech Therapy LLC Speech-Language Pathologist Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 14297262 CO
Speech-Language Pathologist 235Z00000X 17185 OR Yes

Addresses

Primary practice location

34651 SE Kelso Rd
Boring, OR 97009-7041

Mailing address

1425 SW Clay St Apt 304
Portland, OR 97201-6008
Phone (608) 213-6956

Other practice location 1

12240 SE School Ave
Boring, OR 97009-7488
Phone (503) 668-4454

Other providers in Boring, OR

All providers in Boring, OR · Speech-Language Pathologist in Oregon

Sources for this page

Verify at the official NPI Registry.