Active NPI
Mikala Soroka Fleegle
- Speech-Language Pathologist
- Beaverton, OR
National Provider Identifier
1972080018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 16877
- Practice address
- 14475 SW Barrows Rd
Beaverton, OR 97007-6103 - Phone
- (503) 376-6850
- NPI assigned
- Jul 22, 2018
- 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 | SP-2352 | NV | |
| Speech-Language Pathologist | 235Z00000X | 16877 | OR | Primary |
Addresses
Primary practice location
14475 SW Barrows Rd
Beaverton, OR 97007-6103
Mailing address
3750 S River Pkwy Apt 227
Portland, OR 97239-4746
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-2352 | NV | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1972080018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3750 S RIVER PKWY APT 227",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972394746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14475 SW BARROWS RD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970076103",
"telephone_number": "503-376-6850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLEEGLE",
"first_name": "MIKALA",
"middle_name": "SOROKA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-22",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NV",
"license": "SP-2352",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "16877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.