Provider Demographics
NPI:1285982298
Name:SHORES, KAREN HEATH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:HEATH
Last Name:SHORES
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 1:522 BUNKERS COVE RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3916
Mailing Address - Country:US
Mailing Address - Phone:850-867-1084
Mailing Address - Fax:
Practice Address - Street 1:522 BUNKERS COVE RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3916
Practice Address - Country:US
Practice Address - Phone:850-867-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist