Provider Demographics
NPI:1710176102
Name:TRINGHAM, KAREN SUE (MA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:TRINGHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 AVENIDA DE DIAMANTE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1938
Mailing Address - Country:US
Mailing Address - Phone:805-489-6518
Mailing Address - Fax:
Practice Address - Street 1:670 AVENIDA DE DIAMANTE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1938
Practice Address - Country:US
Practice Address - Phone:805-489-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP0045700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6568625Medicaid