Provider Demographics
NPI:1427533702
Name:CURTIS-WALLACE, KAREN MARGUERITE (MA,BS,L-SLP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARGUERITE
Last Name:CURTIS-WALLACE
Suffix:
Gender:F
Credentials:MA,BS,L-SLP
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MARGUERITE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4652 SAINT ROCH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-5033
Mailing Address - Country:US
Mailing Address - Phone:504-228-4156
Mailing Address - Fax:504-267-7792
Practice Address - Street 1:4652 SAINT ROCH AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-5033
Practice Address - Country:US
Practice Address - Phone:504-228-4156
Practice Address - Fax:504-267-7792
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist