Provider Demographics
NPI:1972587236
Name:MACK, KAROLYN JUNE (MS/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KAROLYN
Middle Name:JUNE
Last Name:MACK
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 1:1315 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CROSS JUNCTION
Mailing Address - State:VA
Mailing Address - Zip Code:22625-2517
Mailing Address - Country:US
Mailing Address - Phone:540-247-2323
Mailing Address - Fax:540-450-2707
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-2931
Practice Address - Fax:540-636-8161
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist