Provider Demographics
NPI:1104934868
Name:SMITH, KAREN WELLER (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:WELLER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 COLUMBIA RD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1487
Mailing Address - Country:US
Mailing Address - Phone:440-808-9469
Mailing Address - Fax:440-808-9532
Practice Address - Street 1:805 COLUMBIA RD
Practice Address - Street 2:SUITE #111
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1487
Practice Address - Country:US
Practice Address - Phone:440-808-9469
Practice Address - Fax:440-808-9532
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01028999231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11364544OtherCAQH