Provider Demographics
NPI:1710205588
Name:NANCE MORTON, KAREN DIANE (SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:NANCE MORTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DIANE
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-0952
Mailing Address - Country:US
Mailing Address - Phone:936-639-3036
Mailing Address - Fax:936-639-3064
Practice Address - Street 1:360 NORTH JOHN REDDITT DRIVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2606
Practice Address - Country:US
Practice Address - Phone:936-639-3036
Practice Address - Fax:936-639-3064
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00764365OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOC (ASHA)