Provider Demographics
NPI:1912279068
Name:KANNEBERG, KARIN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:
Last Name:KANNEBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 COASTAL HIGHWAY 17
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:RICHMNOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:912-756-5388
Practice Address - Street 1:2709 COASTAL HIGHWAY 17
Practice Address - Street 2:SUITE 2A
Practice Address - City:RICHMNOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-5699
Practice Address - Fax:912-756-5388
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist