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Individual

CAROL PONTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
1021 NW HIGHLAND AVE, GRANTS PASS, OR 97526-1146
(541) 474-5495
Mailing address
1021 NW HIGHLAND AVE, GRANTS PASS, OR 97526-1146

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10490
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
195230
OR
Enumeration date
09/20/2006
Last updated
07/08/2007
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