Provider Demographics
NPI:1841319282
Name:FETSKO, KAREN ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANNE
Last Name:FETSKO
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 1:12531 LINEAGE CIR NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-5708
Mailing Address - Country:US
Mailing Address - Phone:330-699-9578
Mailing Address - Fax:
Practice Address - Street 1:1420 SMITH KRAMER ST NE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-8730
Practice Address - Country:US
Practice Address - Phone:330-877-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist