Provider Demographics
NPI:1134340177
Name:SULZMAN, KAREN ELLEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELLEN
Last Name:SULZMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LUBIN
Other - Last Name:SULZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18 WELDON WOODS RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4610
Mailing Address - Country:US
Mailing Address - Phone:203-312-0105
Mailing Address - Fax:
Practice Address - Street 1:18 WELDON WOODS RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-4610
Practice Address - Country:US
Practice Address - Phone:203-312-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002862235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005618OtherSTATE LICENSE
CT002862OtherSTATE DEPT. OF HEALTH
01026756-02OtherASHA