Provider Demographics
NPI:1972704575
Name:WIRES, KAREN N (CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:N
Last Name:WIRES
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 ENGLISH DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4330
Mailing Address - Country:US
Mailing Address - Phone:703-764-8051
Mailing Address - Fax:703-385-8353
Practice Address - Street 1:3959 PENDER DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6041
Practice Address - Country:US
Practice Address - Phone:703-352-3822
Practice Address - Fax:703-385-8353
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist