Provider Demographics
NPI:1326328857
Name:FREUDENDORF, KAREN VIRGINIA (MS,CCC/LSP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:VIRGINIA
Last Name:FREUDENDORF
Suffix:
Gender:F
Credentials:MS,CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JERUSALEM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3122
Mailing Address - Country:US
Mailing Address - Phone:631-878-9561
Mailing Address - Fax:631-878-9561
Practice Address - Street 1:4 JERUSALEM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3122
Practice Address - Country:US
Practice Address - Phone:631-878-9561
Practice Address - Fax:631-878-9561
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005621-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist