Provider Demographics
NPI:1134494701
Name:SHUSTERMAN, KAREN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SHUSTERMAN
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 1:12794 FOREST HILL BLVD
Mailing Address - Street 2:SUITE #30
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4710
Mailing Address - Country:US
Mailing Address - Phone:561-358-8043
Mailing Address - Fax:561-753-4911
Practice Address - Street 1:12794 FOREST HILL BLVD
Practice Address - Street 2:SUITE #30
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-358-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist