Provider Demographics
NPI:1194907733
Name:KOYMEN, KARA BUSH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:BUSH
Last Name:KOYMEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:ANNE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5900 METRO DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3207
Mailing Address - Country:US
Mailing Address - Phone:410-318-6780
Mailing Address - Fax:410-318-6759
Practice Address - Street 1:5900 METRO DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3207
Practice Address - Country:US
Practice Address - Phone:410-318-6780
Practice Address - Fax:410-318-6759
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ175-0032OtherCAREFIRST BCBS
MD615396-03OtherCAREFIRST BCBS
MD615396-02OtherCAREFIRST BCBS