Provider Demographics
NPI:1235148586
Name:DEWEESE, KARI LYN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:LYN
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 HUNTERS CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1713
Mailing Address - Country:US
Mailing Address - Phone:561-502-8487
Mailing Address - Fax:469-362-2954
Practice Address - Street 1:5365 HUNTERS CREEK TRL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1713
Practice Address - Country:US
Practice Address - Phone:561-502-8487
Practice Address - Fax:469-362-2954
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6981235Z00000X
TX103509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888288600Medicaid