Provider Demographics
NPI:1427568088
Name:RYKER, KARA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:RYKER
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 1:1865 BOLD SPRINGS RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4605
Mailing Address - Country:US
Mailing Address - Phone:770-267-1055
Mailing Address - Fax:
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD BLDG G
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3001
Practice Address - Country:US
Practice Address - Phone:770-622-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLPO10270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist