Provider Demographics
NPI:1316292576
Name:BARRY, KAREN SUE (SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:BARRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:BURNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:14 VALKYRIE RIDE
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-1155
Mailing Address - Country:US
Mailing Address - Phone:636-614-5747
Mailing Address - Fax:
Practice Address - Street 1:1035 PLAZA CT N
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-1129
Practice Address - Country:US
Practice Address - Phone:636-629-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007005972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist