Provider Demographics
NPI:1164609301
Name:ALEXANDER, KAREN BOARD (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:BOARD
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MEMORIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4608
Mailing Address - Country:US
Mailing Address - Phone:304-638-9230
Mailing Address - Fax:
Practice Address - Street 1:820 MEMORIAL PARK DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4608
Practice Address - Country:US
Practice Address - Phone:304-638-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32235Z00000X
WV59235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0155815000Medicaid