Provider Demographics
NPI:1972712545
Name:FAY, KAREN ANN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:FAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2620
Mailing Address - Country:US
Mailing Address - Phone:928-776-4349
Mailing Address - Fax:928-776-1369
Practice Address - Street 1:340 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2620
Practice Address - Country:US
Practice Address - Phone:928-776-4349
Practice Address - Fax:928-776-1369
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 0736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ801606OtherAHCCCS