Provider Demographics
NPI:1154442127
Name:FRICKS, KAREN C (SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:FRICKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 FORKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6139
Mailing Address - Country:US
Mailing Address - Phone:404-421-4671
Mailing Address - Fax:770-222-0266
Practice Address - Street 1:113 FORKWOOD WAY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6139
Practice Address - Country:US
Practice Address - Phone:404-421-4671
Practice Address - Fax:770-222-0266
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist