Provider Demographics
NPI:1154595205
Name:WOOD, KAREN ELAINE (MA-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELAINE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 SUNNY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-2710
Mailing Address - Country:US
Mailing Address - Phone:573-459-2209
Mailing Address - Fax:
Practice Address - Street 1:4172 SUNNY RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-2710
Practice Address - Country:US
Practice Address - Phone:573-459-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154595205OtherNATIONAL PROVIDER IDENTIFIER
MO856288303Medicaid