Provider Demographics
NPI:1063167732
Name:MORAN, KAREN MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:MORAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5900 EVERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1699
Mailing Address - Country:US
Mailing Address - Phone:210-397-2100
Mailing Address - Fax:
Practice Address - Street 1:1256 PINN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1828
Practice Address - Country:US
Practice Address - Phone:210-397-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist