Basic Information
| Provider Information | |||||||||
| NPI: | 1831792704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARTH | ||||||||
| FirstName: | COLBY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 222 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978120222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412631004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978501387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419638421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2020 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14225722 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.