Provider Demographics
NPI:1760760227
Name:CHENEY, KAREN L (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:CHENEY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12668 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7602
Mailing Address - Country:US
Mailing Address - Phone:317-826-1853
Mailing Address - Fax:317-221-7804
Practice Address - Street 1:12668 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7602
Practice Address - Country:US
Practice Address - Phone:317-826-1853
Practice Address - Fax:317-221-7804
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004606A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004606AOtherSTATE SPEECH LICENSE