Provider Demographics
NPI:1740864966
Name:CRISP, KAREN ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:CRISP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8648 LUPINE LOOP DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-2048
Mailing Address - Country:US
Mailing Address - Phone:661-675-6366
Mailing Address - Fax:
Practice Address - Street 1:8648 LUPINE LOOP DR APT 3
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2048
Practice Address - Country:US
Practice Address - Phone:661-675-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14035142OtherASHA MEMBER NUMBER
CA19401OtherDCA