Active NPI
Kerry Anne Roediger, SLP
- Speech-Language Pathologist
- Portland, OR
National Provider Identifier
1528006368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12293
- Practice address
- 1722 NW Raleigh St
Suite 318
Portland, OR 97209-1753 - Phone
- (503) 224-2820
- Fax
- (503) 224-2607
- NPI assigned
- Jun 3, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | LL00003688 | WA | |
| Speech-Language Pathologist | 235Z00000X | 12293 | OR | Primary |
Addresses
Primary practice location
1722 NW Raleigh St
Suite 318
Portland, OR 97209-1753
Mailing address
1722 NW Raleigh St
Suite 318
Portland, OR 97209-1753
Phone (503) 224-2820
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09138419 | Other | ASHA CERTIFICATION - SLP | |
| 182755 | Medicaid | OR | |
| 12293 | Other | OR | OREGON LICENSE - SLP |
| 7131154 | Medicaid | WA | |
| LL00003688 | Other | WA | WAHINGTON LICENSE - SLP |
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 |
|---|---|---|---|
| 12293 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| LL00003688 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1528006368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1722 NW RALEIGH ST",
"address_2": "SUITE 318",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091753",
"telephone_number": "503-224-2820",
"fax_number": "503-224-2607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1722 NW RALEIGH ST",
"address_2": "SUITE 318",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091753",
"telephone_number": "503-224-2820",
"fax_number": "503-224-2607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEDIGER",
"first_name": "KERRY",
"middle_name": "ANNE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-03",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL00003688",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "12293",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFICATION - SLP",
"identifier": "09138419",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182755",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON LICENSE - SLP",
"identifier": "12293",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7131154",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WAHINGTON LICENSE - SLP",
"identifier": "LL00003688",
"state": "WA"
}
],
"endpoints": [],
"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 Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.