Molly Ann Prideaux

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12646 Issued in OR

Practice address

19185 SW 90TH Ave
Tualatin, OR 97062-7558

Phone

(503) 885-7300

NPI assigned

Aug 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Molly Ann Lancaster Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1427166966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5288 BROADWAY ST",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683306",
            "telephone_number": "541-510-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19185 SW 90TH AVE",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627558",
            "telephone_number": "503-885-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDEAUX",
        "first_name": "MOLLY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "12646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "19185 SW 90th Ave",
            "city": "Tualatin",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970627558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "LANCASTER",
            "middle_name": "ANN",
            "credential": "SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Lynn Polas, DPT
• Tracy Lynn Policar, COTA
• Jeffrey Michael Pollock, MD
• Christine Prentice, APRN-RX
• Jessica Preston
• Prine Counseling, LLC
• Proactive Physical Therapy Tualatin
• Elizabeth Pruett, NP
• Anela Puljic, MD
• Emily W Puterbaugh, MD

• Speech-Language Pathologist in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.