Provider Demographics
NPI:1467507988
Name:AGUILERA, KAREN A (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68696
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0696
Mailing Address - Country:US
Mailing Address - Phone:503-449-2695
Mailing Address - Fax:
Practice Address - Street 1:4212 SE HULL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-6443
Practice Address - Country:US
Practice Address - Phone:503-449-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR838353004OtherBLUE CROSS PROVIDER NUMBE
OR158286Medicaid