Provider Demographics
NPI:1851699185
Name:BLACK, KAREN S (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:BLACK
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MILL LANE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-387-4311
Mailing Address - Fax:540-389-6212
Practice Address - Street 1:126 MILL LANE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-387-4311
Practice Address - Fax:540-389-6212
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist