Provider Demographics
NPI:1598850372
Name:SERRETT, KAREN M (SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SERRETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:SIDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:182 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1811
Mailing Address - Country:US
Mailing Address - Phone:315-255-2746
Mailing Address - Fax:315-255-2740
Practice Address - Street 1:182 NORTH STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-255-2746
Practice Address - Fax:315-255-2740
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1295292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist