Provider Demographics
NPI:1376930560
Name:RETRUM, KARLA RENAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:RENAE
Last Name:RETRUM
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 1:4510 FOREST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-1104
Mailing Address - Country:US
Mailing Address - Phone:715-551-9281
Mailing Address - Fax:
Practice Address - Street 1:4510 FOREST VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-1104
Practice Address - Country:US
Practice Address - Phone:715-802-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist