Active NPI
Debra Lynn Greenholtz-Carrillo, MS CCC SCP
- Speech-Language Pathologist
- Vancouver, WA
National Provider Identifier
1407027758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 13045
- Practice address
- 201 NE Park Plaza Dr
Suite 246
Vancouver, WA 98684 - Phone
- (360) 696-2070
- Fax
- (360) 737-0200
- NPI assigned
- Mar 14, 2008
- Last updated
- Nov 21, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 13045 | OR | Primary |
Addresses
Primary practice location
201 NE Park Plaza Dr
Suite 246
Vancouver, WA 98684
Mailing address
17845 NW Sedgewick CT
Beaverton, OR 97006
Phone (503) 645-0901
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13045 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1407027758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17845 NW SEDGEWICK CT",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97006",
"telephone_number": "503-645-0901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 NE PARK PLAZA DR",
"address_2": "SUITE 246",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98684",
"telephone_number": "360-696-2070",
"fax_number": "360-737-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENHOLTZ-CARRILLO",
"first_name": "DEBRA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "MS CCC SCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "13045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.