Provider Demographics
NPI:1720089709
Name:MOELLMAN, KAREN SUE (MA, CCC,)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:MOELLMAN
Suffix:
Gender:F
Credentials:MA, CCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-0509
Mailing Address - Country:US
Mailing Address - Phone:419-862-3434
Mailing Address - Fax:
Practice Address - Street 1:5950 AIRPORT HWY STE 17
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7362
Practice Address - Country:US
Practice Address - Phone:419-865-7500
Practice Address - Fax:419-865-8532
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00858231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741482OtherMEDICARE PTAN
OH640004708Medicare ID - Type UnspecifiedMEDICARE RAILROAD
OH0741482OtherMEDICARE PTAN
OHMO0741482Medicare PIN