Provider Demographics
NPI:1902051998
Name:PICKARD, KAREN MAE (SLP)
Entity type:Individual
Prefix:MR
First Name:KAREN
Middle Name:MAE
Last Name:PICKARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2039
Mailing Address - Country:US
Mailing Address - Phone:585-345-9431
Mailing Address - Fax:
Practice Address - Street 1:1360 EGGERT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3354
Practice Address - Country:US
Practice Address - Phone:716-835-0417
Practice Address - Fax:716-835-2648
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007380-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist