Basic Information
| Provider Information | |||||||||
| NPI: | 1083208052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGLIEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | GAYLE | ||||||||
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| Credential: | MHS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5049 DANIEL ST S | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973062062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734247946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 890 OAK ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2021 | ||||||||
| LastUpdateDate: | 02/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 13093 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.