Provider Demographics
NPI:1306112768
Name:VERSAW, KARA JAN
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:JAN
Last Name:VERSAW
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 1:19657 PINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2998
Mailing Address - Country:US
Mailing Address - Phone:402-657-5077
Mailing Address - Fax:
Practice Address - Street 1:19657 PINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2998
Practice Address - Country:US
Practice Address - Phone:402-657-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1454235Z00000X
IA002212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist