Provider Demographics
NPI:1417114810
Name:CANTRELL, KARLEN J (MA CCS SLP)
Entity Type:Individual
Prefix:
First Name:KARLEN
Middle Name:J
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MA CCS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LAKEVIEW DR
Mailing Address - Street 2:STE 102
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1532
Mailing Address - Country:US
Mailing Address - Phone:806-468-9400
Mailing Address - Fax:806-468-9401
Practice Address - Street 1:2400 LAKEVIEW DR
Practice Address - Street 2:STE 102
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1532
Practice Address - Country:US
Practice Address - Phone:806-468-9400
Practice Address - Fax:806-468-9401
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465734408Medicaid