Provider Demographics
NPI:1407181175
Name:KLINE, COREY W (HAS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:W
Last Name:KLINE
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1139
Mailing Address - Country:US
Mailing Address - Phone:503-261-9309
Mailing Address - Fax:503-261-9311
Practice Address - Street 1:8505 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1139
Practice Address - Country:US
Practice Address - Phone:503-261-9309
Practice Address - Fax:503-261-9311
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-339566237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist