Provider Demographics
NPI:1881843944
Name:MCBRIDE, KAREN LEE (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MACCCSLP
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 92
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-0092
Mailing Address - Country:US
Mailing Address - Phone:917-753-4585
Mailing Address - Fax:
Practice Address - Street 1:13 OSBORN RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-1433
Practice Address - Country:US
Practice Address - Phone:917-753-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012679235Z00000X
CA4774235Z00000X
MESP2501235Z00000X
CT007078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist