Provider Demographics
NPI:1306730155
Name:TEGNER, ISABELLE ANN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ISABELLE
Middle Name:ANN
Last Name:TEGNER
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 1:828 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-0287
Mailing Address - Country:US
Mailing Address - Phone:541-326-6079
Mailing Address - Fax:
Practice Address - Street 1:828 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525-0287
Practice Address - Country:US
Practice Address - Phone:541-326-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist