Provider Demographics
NPI:1740412816
Name:PRESTON, KAREN MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MICHELLE
Last Name:PRESTON
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 1:199 FEN WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4317
Mailing Address - Country:US
Mailing Address - Phone:516-584-6027
Mailing Address - Fax:
Practice Address - Street 1:199 FEN WAY
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4317
Practice Address - Country:US
Practice Address - Phone:516-584-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011812-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist