Active NPI
Marie Pascale Soderstrom, M.S.,SLP
- Speech-Language Pathologist
- Medford, OR
National Provider Identifier
1336370329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 13249
- Practice address
- 3144 State St
Medford, OR 97504-8450 - Phone
- (541) 773-8255
- Fax
- (541) 773-8256
- NPI assigned
- Aug 7, 2009
- Sex
- Female
- 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 | 13249 | OR | Primary |
Addresses
Primary practice location
3144 State St
Medford, OR 97504-8450
Mailing address
3144 State St
Medford, OR 97504-8450
Phone (541) 773-8255
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13249 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249603200000",
"number": "1336370329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3144 STATE ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048450",
"telephone_number": "541-773-8255",
"fax_number": "541-773-8256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3144 STATE ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048450",
"telephone_number": "541-773-8255",
"fax_number": "541-773-8256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODERSTROM",
"first_name": "MARIE",
"middle_name": "PASCALE",
"credential": "M.S.,SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-07",
"last_updated": "2009-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "13249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.