Provider Demographics
NPI:1558657866
Name:HIBBS, KAREN (SLP MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HIBBS
Suffix:
Gender:F
Credentials:SLP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 N PEPPARD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4204
Mailing Address - Country:US
Mailing Address - Phone:208-866-5976
Mailing Address - Fax:
Practice Address - Street 1:3086 W MILANO DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7288
Practice Address - Country:US
Practice Address - Phone:208-996-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8Q308OtherBLUE CROSS OF IDAHO
ID1558657866Medicaid