Provider Demographics
NPI:1972900744
Name:MIDDLESWARTH, KAREN L
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MIDDLESWARTH
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:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-0116
Mailing Address - Country:US
Mailing Address - Phone:419-483-4916
Mailing Address - Fax:419-483-4916
Practice Address - Street 1:104 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9056
Practice Address - Country:US
Practice Address - Phone:419-483-4916
Practice Address - Fax:419-483-4916
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-1169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist