Provider Demographics
NPI:1326290404
Name:LAVANCHA, KAREN LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:LAVANCHA
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 1:14 SUNNYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-8807
Mailing Address - Country:US
Mailing Address - Phone:607-753-6681
Mailing Address - Fax:
Practice Address - Street 1:14 SUNNYFIELD DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-8807
Practice Address - Country:US
Practice Address - Phone:607-753-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013789-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist