Basic Information
| Provider Information | |||||||||
| NPI: | 1093477358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITING | ||||||||
| FirstName: | MIYKA | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19431 ORCHARD GROVE DR | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970457129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035052591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD STE 362 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032162610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2021 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 17304 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 14415087 | 05 | OR | MEDICAID |