Provider Demographics
NPI:1598473720
Name:THOMASSEN, KARIN (MA CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:THOMASSEN
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2136
Mailing Address - Country:US
Mailing Address - Phone:631-512-5726
Mailing Address - Fax:
Practice Address - Street 1:34 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2136
Practice Address - Country:US
Practice Address - Phone:631-512-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist