Provider Demographics
NPI:1891020681
Name:FLORIANO-HEIMERL, KAREN R (SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:FLORIANO-HEIMERL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 HERFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54141-9127
Mailing Address - Country:US
Mailing Address - Phone:920-826-6511
Mailing Address - Fax:
Practice Address - Street 1:3305 N BALLARD RD STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-9001
Practice Address - Country:US
Practice Address - Phone:920-735-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2363-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist