Provider Demographics
NPI:1497906770
Name:TRACHTENBERG, KAREN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TRACHTENBERG
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 1:91-1443 KAIKOHOLA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6521
Mailing Address - Country:US
Mailing Address - Phone:845-699-1449
Mailing Address - Fax:808-892-1021
Practice Address - Street 1:91-1443 KAIKOHOLA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6521
Practice Address - Country:US
Practice Address - Phone:845-699-1449
Practice Address - Fax:808-892-1021
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01382-1235Z00000X
HI1444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist