Healthcare Provider Details

I. General information

NPI: 1215687645
Provider Name (Legal Business Name): KAREN COOPER OLMSTED CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N THEARD ST
COVINGTON LA
70433-2835
US

IV. Provider business mailing address

1825 OCTAVIA DR
MANDEVILLE LA
70448-1025
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-0837
  • Fax:
Mailing address:
  • Phone: 504-250-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2267
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: