Basic Information
| Provider Information | |||||||||
| NPI: | 1720355225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH- LADORE | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | MAKANA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SLPA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | MAKANA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.S., CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 8082425835 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 ALEXANDER LOOP | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974016524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413456199 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2011 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 15393 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.