Provider Demographics
NPI:1265756662
Name:SPINA, KAREN L (SLP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:SPINA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3027
Mailing Address - Country:US
Mailing Address - Phone:239-643-2040
Mailing Address - Fax:239-643-2080
Practice Address - Street 1:3841 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6201
Practice Address - Country:US
Practice Address - Phone:239-732-9094
Practice Address - Fax:239-732-9098
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist