Healthcare Provider Details

I. General information

NPI: 1568079119
Provider Name (Legal Business Name): KARISSA ANN PERCHINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARISSA GONDAK

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BAKERS RIDGE RD
MORGANTOWN WV
26508-1459
US

IV. Provider business mailing address

661 VANCEVILLE RD
EIGHTY FOUR PA
15330-1941
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-0692
  • Fax:
Mailing address:
  • Phone: 724-953-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12115
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: