Provider Demographics
NPI:1326293408
Name:WASSON, KAREN L (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:WASSON
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:DOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:1919 E LETTS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7912
Mailing Address - Country:US
Mailing Address - Phone:248-982-8324
Mailing Address - Fax:
Practice Address - Street 1:4000 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670
Practice Address - Country:US
Practice Address - Phone:989-832-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001977235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist