Provider Demographics
NPI:1093019317
Name:GAINES, KAREN LESLIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LESLIE
Last Name:GAINES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LOU ANN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3415
Mailing Address - Country:US
Mailing Address - Phone:540-230-3298
Mailing Address - Fax:
Practice Address - Street 1:624 LOU ANN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3415
Practice Address - Country:US
Practice Address - Phone:540-230-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist