MEDICARE: MS. CHRISTINE CORL SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146.008759	IL
2	235Z00000X	Speech-Language Pathologist	LL60507478	WA
3	235Z00000X	Speech-Language Pathologist	17385	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146.008759	OTHER	IL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12096071	OTHER	IL	ASHA

General Provider Information

NPI Number	:	1538385802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE CORL SLP

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 SW BARNES RD STE 561
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-6643
Country	:	US
Telephone Number	:	503-216-2339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/21/2023

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