Provider Demographics
NPI:1871360958
Name:CHIN, CHERI DODGE (CLINSCD, CCC/SLP)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:DODGE
Last Name:CHIN
Suffix:
Gender:F
Credentials:CLINSCD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 SE 172ND AVE
Mailing Address - Street 2:SUITE 166, PMB 2068
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8738
Mailing Address - Country:US
Mailing Address - Phone:503-882-0450
Mailing Address - Fax:
Practice Address - Street 1:7927 SE ORIENT DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8847
Practice Address - Country:US
Practice Address - Phone:503-663-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist