Provider Demographics
NPI:1538540554
Name:LEMONCELLO, RICHARD R (PHD, CCC/SLP)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:LEMONCELLO
Suffix:
Gender:M
Credentials:PHD, CCC/SLP
Other - Prefix:
Other - First Name:RIK
Other - Middle Name:
Other - Last Name:LEMONCELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9424 SW WOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5169
Mailing Address - Country:US
Mailing Address - Phone:503-360-4360
Mailing Address - Fax:
Practice Address - Street 1:2043 COLLEGE WAY
Practice Address - Street 2:PACIFIC UNIVERSITY / SCHOOL OF CSD
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:503-352-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12474OtherOR LICENSE TO PRACTICE SPEECH-LANGUAGE PATHOLOGY
12027743OtherASHA NATIONAL CERTIFICATION