Provider Demographics
NPI:1154860211
Name:MARTIN, KAREN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S STADIUM HL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-0740
Mailing Address - Country:US
Mailing Address - Phone:865-974-0635
Mailing Address - Fax:
Practice Address - Street 1:1600 PEYTON MANNING PASS
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0740
Practice Address - Country:US
Practice Address - Phone:865-974-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist