Provider Demographics
NPI:1619023538
Name:PRENDERGAST, CHRISTINE BARBARA
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:BARBARA
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 TROY CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7306
Mailing Address - Country:US
Mailing Address - Phone:503-723-0104
Mailing Address - Fax:503-723-0104
Practice Address - Street 1:2551 TROY CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7306
Practice Address - Country:US
Practice Address - Phone:503-723-0104
Practice Address - Fax:503-723-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA 28049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist