Active NPI
Denice Michelle Edeal, CCC-SLP
- Speech-Language Pathologist
- Newberg, OR
National Provider Identifier
1992069975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 13086
- Practice address
- 201 N Meridian St
Suite B
Newberg, OR 97132-2752 - Phone
- (503) 901-5652
- NPI assigned
- Jun 25, 2012
- 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 | 13086 | OR | Primary |
Addresses
Primary practice location
201 N Meridian St
Suite B
Newberg, OR 97132-2752
Mailing address
2000 NE 42ND Ave # 209
Portland, OR 97213-1399
Phone (503) 309-1089
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 |
|---|---|---|---|
| 13086 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340582400000",
"number": "1992069975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 NE 42ND AVE # 209",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972131399",
"telephone_number": "503-309-1089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 N MERIDIAN ST",
"address_2": "SUITE B",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971322752",
"telephone_number": "503-901-5652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDEAL",
"first_name": "DENICE",
"middle_name": "MICHELLE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-25",
"last_updated": "2012-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "13086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.