Provider Demographics
NPI:1558146811
Name:CORDOVES, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CORDOVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 MONUMENT DR UNIT 1438
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1288
Mailing Address - Country:US
Mailing Address - Phone:786-973-2599
Mailing Address - Fax:
Practice Address - Street 1:1020 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3667
Practice Address - Country:US
Practice Address - Phone:941-499-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist