Provider Demographics
NPI:1386778470
Name:SCOTT, KAREN M (AUD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 SOUTH HIGUERA STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6987
Mailing Address - Country:US
Mailing Address - Phone:805-541-1790
Mailing Address - Fax:805-541-1793
Practice Address - Street 1:3220 SOUTH HIGUERA STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6987
Practice Address - Country:US
Practice Address - Phone:805-541-1790
Practice Address - Fax:805-541-1793
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 158237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ49563ZMedicaid
CAAUD158Medicare ID - Type Unspecified
CAZZZ49563ZMedicaid