Provider Demographics
NPI:1144232448
Name:IVERSON, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:IVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GRAYBEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6601
Mailing Address - Country:US
Mailing Address - Phone:541-667-3635
Mailing Address - Fax:541-667-3454
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6601
Practice Address - Country:US
Practice Address - Phone:541-667-3635
Practice Address - Fax:541-667-3454
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist