Provider Demographics
NPI:1902538150
Name:VAN WETERING, KARA LINDSAY
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LINDSAY
Last Name:VAN WETERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PLEASANT LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4764
Mailing Address - Country:US
Mailing Address - Phone:407-967-6565
Mailing Address - Fax:
Practice Address - Street 1:19 PLEASANT LN UNIT A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4764
Practice Address - Country:US
Practice Address - Phone:407-967-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist