Provider Demographics
NPI:1679179766
Name:MARUGG, KARISSA
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:MARUGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-0991
Mailing Address - Country:US
Mailing Address - Phone:971-832-1051
Mailing Address - Fax:
Practice Address - Street 1:2855 E HAYES ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1390
Practice Address - Country:US
Practice Address - Phone:503-901-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist