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NPI Code Detail

MEDICARE: KARA LYNN RANDALL SLP

MEDICARE: KARA LYNN RANDALL SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2021009057MO

General Provider Information

NPI Number : 1073186045
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARA LYNN RANDALL SLP
Provider Business Mailing Address
First Line : 1330 DOLMAN ST APT 108
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-2908
Country : US
Telephone Number : 219-677-0592
Fax Number :
Provider Business Practice Location Address
First Line : 2963 DODDRIDGE AVE
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-1736
Country : US
Telephone Number : 314-291-4557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2021
Last Update Date : 07/19/2021

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Directions to “ KARA LYNN RANDALL SLP” Practice Location

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