=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982727301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN SUE REISCHKE MA CCC-SLP/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 01/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 NEW RD STE 38
-----------------------------------------------------
City | LINWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08221-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-703-6741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 FREDERICK AVE
-----------------------------------------------------
City | MARMORA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08223-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-639-6782
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SL005599L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------