Healthcare Provider Details

I. General information

NPI: 1003586108
Provider Name (Legal Business Name): KAREN HURTADO MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SCOTT DR
HURST TX
76053-4213
US

IV. Provider business mailing address

1849 CENTRAL DR
BEDFORD TX
76022-6017
US

V. Phone/Fax

Practice location:
  • Phone: 817-399-3410
  • Fax:
Mailing address:
  • Phone: 817-283-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: