Provider Demographics
NPI:1891910030
Name:WEYBRIGHT, GLENN DOUGLAS (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:DOUGLAS
Last Name:WEYBRIGHT
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7810 SW CALAVERAS CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5932
Mailing Address - Country:US
Mailing Address - Phone:503-641-1976
Mailing Address - Fax:503-227-0676
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:405
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2859
Practice Address - Country:US
Practice Address - Phone:503-419-4930
Practice Address - Fax:503-227-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist