Provider Demographics
NPI:1831358225
Name:DUNN, LARA KRISTIN (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:KRISTIN
Last Name:DUNN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1421
Mailing Address - Country:US
Mailing Address - Phone:541-380-0752
Mailing Address - Fax:
Practice Address - Street 1:1111 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1421
Practice Address - Country:US
Practice Address - Phone:541-380-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11832235Z00000X
WALL00003725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist