Provider Demographics
NPI:1528187697
Name:DUDEK-BRANNAN, KAREN LARA (EDD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LARA
Last Name:DUDEK-BRANNAN
Suffix:
Gender:F
Credentials:EDD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HOLDER WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704
Mailing Address - Country:US
Mailing Address - Phone:309-212-4862
Mailing Address - Fax:
Practice Address - Street 1:4 HOLDER WAY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8152
Practice Address - Country:US
Practice Address - Phone:309-212-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist