Provider Demographics
NPI:1245744283
Name:SHORT, KAREN ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:SHORT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:CECIL-SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8995 STATE ROUTE 62
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-8442
Mailing Address - Country:US
Mailing Address - Phone:513-673-5173
Mailing Address - Fax:
Practice Address - Street 1:1620 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4869
Practice Address - Country:US
Practice Address - Phone:513-728-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist