Healthcare Provider Details

I. General information

NPI: 1255965133
Provider Name (Legal Business Name): KAREN CODEN MS, CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

6655 CARLYLE CT
WEST BLOOMFIELD MI
48322-3027
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax:
Mailing address:
  • Phone: 248-933-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01069974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: