Provider Demographics
NPI:1184923559
Name:KIBBE, KAREN SUSAN (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUSAN
Last Name:KIBBE
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KIBBE-MICHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:
Practice Address - Street 1:6020 SAN JOSE BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2365
Practice Address - Country:US
Practice Address - Phone:904-425-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1665231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108371AMedicaid
FL0035037-00Medicaid
GA003108371AMedicaid
FLP01052073Medicare PIN