Provider Demographics
NPI:1669538336
Name:DETTMAN, KAREN ANNE (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:DETTMAN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 PROFESSIONAL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3700
Mailing Address - Country:US
Mailing Address - Phone:916-771-6686
Mailing Address - Fax:
Practice Address - Street 1:2120 PROFESSIONAL DR STE 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3700
Practice Address - Country:US
Practice Address - Phone:916-771-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist