Provider Demographics
NPI:1982834396
Name:SUFANA, KAREN KICHO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:KICHO
Last Name:SUFANA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3608
Mailing Address - Country:US
Mailing Address - Phone:219-923-8308
Mailing Address - Fax:219-923-8776
Practice Address - Street 1:1137 AZALEA DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3608
Practice Address - Country:US
Practice Address - Phone:219-923-8308
Practice Address - Fax:219-923-8776
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22000688A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist