Provider Demographics
NPI:1801148606
Name:GAMBOA, KARA RENEE (MS CCC - SLP)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:RENEE
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MS CCC - SLP
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:RENEE
Other - Last Name:HAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC - SLP
Mailing Address - Street 1:1100 34TH ST.
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671
Mailing Address - Country:US
Mailing Address - Phone:360-954-3775
Mailing Address - Fax:360-954-3799
Practice Address - Street 1:1100 34TH ST.
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-954-3775
Practice Address - Fax:360-954-3799
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12027111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist