Basic Information
| Provider Information | |||||||||
| NPI: | 1407181175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8505 SE STARK ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972161139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032619309 | ||||||||
| FaxNumber: | 5032619311 | ||||||||
| Practice Location | |||||||||
| Address1: | 8505 SE STARK ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972161139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032619309 | ||||||||
| FaxNumber: | 5032619311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2009 | ||||||||
| LastUpdateDate: | 10/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-339566 | OR | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.