Provider Demographics
NPI:1982072450
Name:SCHWARTZ, KAREN JILL (MA,, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JILL
Last Name:SCHWARTZ
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:PO BOX 682254
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-2254
Mailing Address - Country:US
Mailing Address - Phone:510-798-3056
Mailing Address - Fax:
Practice Address - Street 1:904 S 300 W
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2450
Practice Address - Country:US
Practice Address - Phone:510-798-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6801200-4102235Z00000X
CASP 20159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist