Provider Demographics
NPI:1245813088
Name:TRAVIS M DOCKTER MS CCC-SLP
Entity type:Organization
Organization Name:TRAVIS M DOCKTER MS CCC-SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DOCKTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:971-282-3575
Mailing Address - Street 1:1907 NE 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1814
Mailing Address - Country:US
Mailing Address - Phone:971-282-3575
Mailing Address - Fax:
Practice Address - Street 1:1907 NE 127TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1814
Practice Address - Country:US
Practice Address - Phone:971-282-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty