Provider Demographics
NPI:1023049566
Name:DAVIS, KAREN KAYLENE (M A)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAYLENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:19580 SCOUT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ONGE
Mailing Address - State:SD
Mailing Address - Zip Code:57779-7913
Mailing Address - Country:US
Mailing Address - Phone:605-491-2832
Mailing Address - Fax:
Practice Address - Street 1:4001 DERBY LN
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2138
Practice Address - Country:US
Practice Address - Phone:605-716-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist