Provider Demographics
NPI:1679077408
Name:KAREN ENNIS, SLP, INC.
Entity Type:Organization
Organization Name:KAREN ENNIS, SLP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:708-296-4562
Mailing Address - Street 1:1709 73RD CT
Mailing Address - Street 2:
Mailing Address - City:ELMOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707
Mailing Address - Country:US
Mailing Address - Phone:708-296-4562
Mailing Address - Fax:888-972-3952
Practice Address - Street 1:1709 73RD CT
Practice Address - Street 2:
Practice Address - City:ELMOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707
Practice Address - Country:US
Practice Address - Phone:708-296-4562
Practice Address - Fax:888-972-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty