Provider Demographics
NPI:1770108003
Name:SIMON, KAREN WORMAN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:WORMAN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELLEN
Other - Last Name:WORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:400 SYBELIA PKWY UNIT 517
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4634
Mailing Address - Country:US
Mailing Address - Phone:407-274-5060
Mailing Address - Fax:
Practice Address - Street 1:445 W AMELIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1128
Practice Address - Country:US
Practice Address - Phone:407-317-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty