Provider Demographics
NPI:1104114719
Name:CLAY CREASEY, KARLA LYNN (MS)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:LYNN
Last Name:CLAY CREASEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:LYNN
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1912 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1708
Mailing Address - Country:US
Mailing Address - Phone:434-845-8765
Mailing Address - Fax:434-845-8467
Practice Address - Street 1:1912 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1708
Practice Address - Country:US
Practice Address - Phone:434-845-8765
Practice Address - Fax:434-845-8467
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist