Basic Information
| Provider Information | |||||||||
| NPI: | 1023507795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | KARISSA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6722 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972286722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712443757 | ||||||||
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| Practice Location | |||||||||
| Address1: | PROVIDENCE PORTLAND MEDICAL CENTER | ||||||||
| Address2: | 4805 NE GLISAN ST | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032151111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2018 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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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 | 15006 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.