Healthcare Provider Details

I. General information

NPI: 1245430867
Provider Name (Legal Business Name): KAREN LYNN ANDERSON MS., CCC/SLP-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 ROCKY BRANCH RD
BETHALTO IL
62010-2540
US

IV. Provider business mailing address

3418 MANASSAS DR
EDWARDSVILLE IL
62025-3209
US

V. Phone/Fax

Practice location:
  • Phone: 618-401-4201
  • Fax: 618-377-7011
Mailing address:
  • Phone: 618-692-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: