Provider Demographics
NPI:1679629497
Name:O'SULLIVAN SEIFERT, KAREN JUNE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JUNE
Last Name:O'SULLIVAN SEIFERT
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1515
Mailing Address - Country:US
Mailing Address - Phone:631-730-6670
Mailing Address - Fax:
Practice Address - Street 1:5 EVANS AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1515
Practice Address - Country:US
Practice Address - Phone:631-730-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010201-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist