Provider Demographics
NPI:1932348836
Name:ACOSTA, KAREN (M ED, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:M ED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3316
Mailing Address - Country:US
Mailing Address - Phone:954-431-4018
Mailing Address - Fax:954-431-4018
Practice Address - Street 1:4105 SW 148TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3316
Practice Address - Country:US
Practice Address - Phone:954-431-4018
Practice Address - Fax:954-431-4018
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885544700Medicaid