Provider Demographics
NPI:1427480128
Name:CUSHMAN, KARA LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:LYNN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 RUTLEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3239
Mailing Address - Country:US
Mailing Address - Phone:209-603-5837
Mailing Address - Fax:
Practice Address - Street 1:2753 RUTLEDGE WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3239
Practice Address - Country:US
Practice Address - Phone:209-603-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist