Provider Demographics
NPI:1215796164
Name:KING, ANN ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:KING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SPRINGHILL DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0701
Mailing Address - Country:US
Mailing Address - Phone:541-967-4518
Mailing Address - Fax:
Practice Address - Street 1:1005 SPRINGHILL DR NW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7551
Practice Address - Country:US
Practice Address - Phone:541-967-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist