Active NPI
Caroline Kornberg, SLP
- Speech-Language Pathologist
- Portland, OR
National Provider Identifier
1811739451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 010840
- Practice address
- 4803 SW Fairhaven Dr
Portland, OR 97221-2615 - Phone
- (503) 869-2512
- NPI assigned
- Jun 12, 2024
- 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 | 010840 | OR | Primary |
Addresses
Primary practice location
4803 SW Fairhaven Dr
Portland, OR 97221-2615
Mailing address
4803 SW Fairhaven Dr
Portland, OR 97221-2615
Phone (503) 869-2512
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 |
|---|---|---|---|
| 010840 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718150400000",
"number": "1811739451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4803 SW FAIRHAVEN DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212615",
"telephone_number": "503-869-2512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4803 SW FAIRHAVEN DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212615",
"telephone_number": "503-869-2512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORNBERG",
"first_name": "CAROLINE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-12",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "010840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.