Provider Demographics
NPI:1427171867
Name:MIETZ, KAREN A (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:MIETZ
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 1:10115 JEFFREYS ST
Mailing Address - Street 2:APT. 2197
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7901
Mailing Address - Country:US
Mailing Address - Phone:702-269-6312
Mailing Address - Fax:
Practice Address - Street 1:10301 JEFFREYS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3922
Practice Address - Country:US
Practice Address - Phone:702-939-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist