Provider Demographics
NPI:1093939506
Name:TITCOMB, KAREN LEE (MS CCCSLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:TITCOMB
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 WINDERMERE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9347
Mailing Address - Country:US
Mailing Address - Phone:219-395-8260
Mailing Address - Fax:
Practice Address - Street 1:3101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6939
Practice Address - Country:US
Practice Address - Phone:219-462-0786
Practice Address - Fax:219-548-7543
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003666A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist