| Doctor Name: | DR. GLEN ROBERT BUCKENDORF |
| NPI Number: | 1912004789 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 10369 |
| Business Practice Address: | 10300 Sw Greenburg Rd Suite 410 Tigard, OR - 972235410 |
| Business Phone Number: | 5035178555 |
| Business Fax Number: | 5035178556 |
| Mailing Address: | 6450 Sw 154th Pl, BEAVERTON |
| State: | OR |
| Postal Code: | 970076823 |
| Phone Number: | 5036469051 |
| Fax Number: | |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 07/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 10369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |