Provider Demographics
NPI:1790807105
Name:LANDIS, KARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:LANDIS
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:PO BOX 39221
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0221
Mailing Address - Country:US
Mailing Address - Phone:317-357-0635
Mailing Address - Fax:317-354-8721
Practice Address - Street 1:1920 ALVEE CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-8779
Practice Address - Country:US
Practice Address - Phone:317-357-0635
Practice Address - Fax:317-354-8721
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003669A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist