Provider Demographics
NPI:1720356579
Name:BLEUEL, KAREN MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:BLEUEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 S PACER LN
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2606
Mailing Address - Country:US
Mailing Address - Phone:321-298-0317
Mailing Address - Fax:
Practice Address - Street 1:2416 S PACER LN
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-2606
Practice Address - Country:US
Practice Address - Phone:321-298-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist