Provider Demographics
NPI:1104127828
Name:KROGG, KAREN GOSKE (SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:GOSKE
Last Name:KROGG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 KENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1222
Mailing Address - Country:US
Mailing Address - Phone:937-845-4480
Mailing Address - Fax:859-371-0899
Practice Address - Street 1:1203 KENNISON AVE
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1222
Practice Address - Country:US
Practice Address - Phone:937-845-4480
Practice Address - Fax:937-845-5029
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10-107235Z00000X
OHSP.10050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist