Active NPI
Candance Lynn Crabill Klynstra, CCC-SLP
- Speech-Language Pathologist
- Bend, OR
National Provider Identifier
1003939208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 015957
- Practice address
- 20840 SE Sunniberg LN
Bend, OR 97702-3759 - Phone
- (630) 220-4867
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146006868 | IL | |
| Speech-Language Pathologist | 235Z00000X | 25397 | CA | |
| Speech-Language Pathologist | 235Z00000X | 015957 | OR | Primary |
Addresses
Primary practice location
20840 SE Sunniberg LN
Bend, OR 97702-3759
Mailing address
20840 SE Sunniberg LN
Bend, OR 97702-3759
Phone (630) 220-4867
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LL 60609843 | Other | WA | SLP LICENSE |
| 25397 | Other | CA | SPEECH PATHOLOGIST |
| 146006868 | Other | IL | STATE LICENSE |
| 15957 | Other | OR | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146006868 | IL | MD | Speech-Language Pathologist |
| 015957 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584316800000",
"number": "1003939208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20840 SE SUNNIBERG LN",
"city": "BEND",
"state": "OR",
"postal_code": "977023759",
"telephone_number": "630-220-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20840 SE SUNNIBERG LN",
"city": "BEND",
"state": "OR",
"postal_code": "977023759",
"telephone_number": "630-220-4867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRABILL KLYNSTRA",
"first_name": "CANDANCE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2020-03-16",
"certification_date": "2020-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146006868",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "25397",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "015957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SLP LICENSE",
"identifier": "LL 60609843",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH PATHOLOGIST",
"identifier": "25397",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "146006868",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "15957",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.