MEDICARE: AUGUST ELAINE GANNETT

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	18175	OR

General Provider Information

NPI Number	:	1841151180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUST ELAINE GANNETT

Provider Business Mailing Address
First Line	:	929 ROSEBUD CT
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-0046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29174 NW KING ST
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-2074
Country	:	US
Telephone Number	:	503-844-1240
Fax Number	:

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

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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Directions to “ AUGUST ELAINE GANNETT ” Practice Location

Language	Start Address	Practice Location

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