Provider Demographics
NPI:1992712780
Name:DORNBUSCH, KAREN LYNN (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:DORNBUSCH
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:CORDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-3117
Mailing Address - Country:US
Mailing Address - Phone:218-894-2439
Mailing Address - Fax:218-894-2295
Practice Address - Street 1:1100 5TH ST NE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-3117
Practice Address - Country:US
Practice Address - Phone:218-894-2439
Practice Address - Fax:218-894-2295
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1364231H00000X
MN7523231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist