Provider Demographics
NPI:1194073668
Name:TESTERMAN, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TESTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1945
Mailing Address - Country:US
Mailing Address - Phone:417-326-5291
Mailing Address - Fax:417-326-3562
Practice Address - Street 1:524 W MADISON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1945
Practice Address - Country:US
Practice Address - Phone:417-326-5291
Practice Address - Fax:417-326-3562
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist