Provider Demographics
NPI:1457111759
Name:TEDROW, KARISSA ELLEN (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:ELLEN
Last Name:TEDROW
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 ABBEY ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7558
Mailing Address - Country:US
Mailing Address - Phone:317-540-0261
Mailing Address - Fax:
Practice Address - Street 1:3895 S KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3540
Practice Address - Country:US
Practice Address - Phone:317-787-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist