Provider Demographics
NPI:1265740187
Name:LIU, KAREN WENDY (CCC/SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:WENDY
Last Name:LIU
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HILL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2021
Mailing Address - Country:US
Mailing Address - Phone:631-754-4431
Mailing Address - Fax:
Practice Address - Street 1:1014 GRAND BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5782
Practice Address - Country:US
Practice Address - Phone:631-243-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist