Provider Demographics
NPI:1689808099
Name:VESCIAL, KAREN (MS CCC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VESCIAL
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12881 KNOTT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3925
Mailing Address - Country:US
Mailing Address - Phone:562-212-2361
Mailing Address - Fax:714-388-3626
Practice Address - Street 1:12881 KNOTT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3925
Practice Address - Country:US
Practice Address - Phone:562-212-2361
Practice Address - Fax:714-388-3626
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist