Provider Demographics
NPI:1609389105
Name:BURNS, KAREN R (MS)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 WASHINGTON AVENUE
Mailing Address - Street 2:STE. E
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:288-865-0117
Mailing Address - Fax:288-865-0119
Practice Address - Street 1:3506 WASHINGTON AVENUE
Practice Address - Street 2:STE E
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:288-865-0117
Practice Address - Fax:288-865-0119
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty