Provider Demographics
NPI:1619561826
Name:CONDOURIS, KAREN LOUISE (SLP/CCC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:CONDOURIS
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 KIRKLAND DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1077
Mailing Address - Country:US
Mailing Address - Phone:978-314-0010
Mailing Address - Fax:
Practice Address - Street 1:260 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1889
Practice Address - Country:US
Practice Address - Phone:978-314-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty