Provider Demographics
NPI:1841336278
Name:BRYANT, KAREN THERESA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:THERESA
Last Name:BRYANT
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 1:10787 N 103RD WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6315
Mailing Address - Country:US
Mailing Address - Phone:480-391-2729
Mailing Address - Fax:480-484-7301
Practice Address - Street 1:12121 N 124TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3473
Practice Address - Country:US
Practice Address - Phone:480-484-7300
Practice Address - Fax:480-484-7301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 0433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626905Medicaid
AZSLP0433OtherAZ HEALTH DEPT LICENSE #