=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962664797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN O'DONNELL SPEECH AND LANGUAGE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2008
-----------------------------------------------------
Last Update Date | 07/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10014 OGLESBY DR
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47720-7435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-867-1733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10014 OGLESBY DR
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47720-7435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-867-1733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. KAREN PARKERSON O'DONNELL
-----------------------------------------------------
Credential | M.A. CCC SLP
-----------------------------------------------------
Telephone | 812-867-1733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 22004056A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------