Provider Demographics
NPI:1831127737
Name:HOLMES, KAREN (MS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:9387 PINE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-2427
Mailing Address - Country:US
Mailing Address - Phone:315-768-6723
Mailing Address - Fax:
Practice Address - Street 1:9387 PINE GROVE LN
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2427
Practice Address - Country:US
Practice Address - Phone:315-768-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004178-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist