Provider Demographics
NPI:1861678609
Name:NUGENT, CAROL L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:NUGENT
Suffix:
Gender:F
Credentials:MS, 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 2081
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-1919
Mailing Address - Country:US
Mailing Address - Phone:503-640-3434
Mailing Address - Fax:503-640-0817
Practice Address - Street 1:1103 NE IRENE CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4044
Practice Address - Country:US
Practice Address - Phone:503-640-3434
Practice Address - Fax:503-640-0817
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist