Healthcare Provider Details

I. General information

NPI: 1083549687
Provider Name (Legal Business Name): MS. KARIN LYNN NYSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 DIVISION ST
OREGON CITY OR
97045-1588
US

IV. Provider business mailing address

4912 SE GRANT ST
PORTLAND OR
97215-3837
US

V. Phone/Fax

Practice location:
  • Phone: 503-657-6747
  • Fax: 503-650-6324
Mailing address:
  • Phone: 503-442-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16939
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: