Provider Demographics
NPI:1093957870
Name:KAREN M SCOTT M A
Entity Type:Organization
Organization Name:KAREN M SCOTT M A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-541-1790
Mailing Address - Street 1:3220 SOUTH HIGUERA STREET
Mailing Address - Street 2:STE. 320
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6987
Mailing Address - Country:US
Mailing Address - Phone:805-541-1790
Mailing Address - Fax:805-541-1793
Practice Address - Street 1:3220 SOUTH HIGUERA STREET
Practice Address - Street 2:STE. 320
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6987
Practice Address - Country:US
Practice Address - Phone:805-541-1790
Practice Address - Fax:805-541-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2031231H00000X
CAAU 158231H00000X
CAHA 4180237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty