Provider Demographics
NPI:1598942534
Name:ANDERSON, KARA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 ULLRICH AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1406
Mailing Address - Country:US
Mailing Address - Phone:512-480-9573
Mailing Address - Fax:
Practice Address - Street 1:5766 BALCONES DR STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4201
Practice Address - Country:US
Practice Address - Phone:512-480-9573
Practice Address - Fax:512-458-9573
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist