Provider Demographics
NPI:1275528507
Name:GOOKIN, KAREN SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:GOOKIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3408 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-2442
Mailing Address - Country:US
Mailing Address - Phone:970-330-2742
Mailing Address - Fax:
Practice Address - Street 1:UNC SPEECH AND AUDIOLOGY CLINIC
Practice Address - Street 2:GUNTER HALL ROOM 0330
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-2012
Practice Address - Fax:970-351-1601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09145127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78438713Medicaid