Provider Demographics
NPI:1497954481
Name:BRACKENBURY, KAREN LEE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:BRACKENBURY
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HEALTH CENTER BUILDING
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0001
Mailing Address - Country:US
Mailing Address - Phone:419-372-2516
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH CENTER BUILDING
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0001
Practice Address - Country:US
Practice Address - Phone:419-372-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist