Provider Demographics
NPI:1215687645
Name:OLMSTED, KAREN COOPER (CCC/SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:COOPER
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 OCTAVIA DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1025
Mailing Address - Country:US
Mailing Address - Phone:504-250-0837
Mailing Address - Fax:
Practice Address - Street 1:321 N THEARD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2835
Practice Address - Country:US
Practice Address - Phone:504-250-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist