Provider Demographics
NPI:1245868702
Name:STAGG, KARON ELAINE (SLP-A)
Entity type:Individual
Prefix:MISS
First Name:KARON
Middle Name:ELAINE
Last Name:STAGG
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 COVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4001
Mailing Address - Country:US
Mailing Address - Phone:941-264-8794
Mailing Address - Fax:
Practice Address - Street 1:20158 CORTEZ BLVB
Practice Address - Street 2:
Practice Address - City:BROOKESVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-796-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI37902355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant