MEDICARE: KATHLEEN CARNEY

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	17697	OR

General Provider Information

NPI Number	:	1356194500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CARNEY

Provider Business Mailing Address
First Line	:	11731 NE GLENN WIDING DR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-9051
Country	:	US
Telephone Number	:	503-261-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	11731 NE GLENN WIDING DR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-9051
Country	:	US
Telephone Number	:	503-261-5535
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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Directions to “ KATHLEEN CARNEY ” Practice Location

Language	Start Address	Practice Location

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