Healthcare Provider Details

I. General information

NPI: 1770108003
Provider Name (Legal Business Name): KAREN WORMAN SIMON M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ELLEN WORMAN M.A. CCC-SLP

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W AMELIA ST
ORLANDO FL
32801-1128
US

IV. Provider business mailing address

400 SYBELIA PKWY UNIT 517
MAITLAND FL
32751-4634
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-3200
  • Fax:
Mailing address:
  • Phone: 407-274-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: