Provider Demographics
NPI:1770553471
Name:LAVALLEY, KAREN JEAN (AU DCCC-A)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JEAN
Last Name:LAVALLEY
Suffix:
Gender:F
Credentials:AU DCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1123
Mailing Address - Country:US
Mailing Address - Phone:940-322-2498
Mailing Address - Fax:940-264-8529
Practice Address - Street 1:1 BURNSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1123
Practice Address - Country:US
Practice Address - Phone:940-322-2498
Practice Address - Fax:940-264-8529
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50294231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80139AMedicare PIN
TX8L7250Medicare PIN