Provider Demographics
NPI:1871373076
Name:TROTTER, TRISTAN FELICITY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:FELICITY
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2724
Mailing Address - Country:US
Mailing Address - Phone:503-577-7605
Mailing Address - Fax:
Practice Address - Street 1:324 N EMERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2724
Practice Address - Country:US
Practice Address - Phone:503-577-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR012919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist