Basic Information
| Provider Information | |||||||||
| NPI: | 1477995041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLENWINKEL | ||||||||
| FirstName: | KARI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 NW 9TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973306173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417685144 | ||||||||
| FaxNumber: | 5417686400 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 NW 9TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973306173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417685144 | ||||||||
| FaxNumber: | 5417686400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2013 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 015100 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 015100 | 01 | OR | OREGON BOARD OF SPEECH LANGUAGE | OTHER |