Provider Demographics
NPI:1295068773
Name:FITTINGER, KAREN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FITTINGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 CIRBY WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6430
Mailing Address - Country:US
Mailing Address - Phone:916-773-8282
Mailing Address - Fax:
Practice Address - Street 1:198 CIRBY WAY STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6430
Practice Address - Country:US
Practice Address - Phone:916-773-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972836971OtherMEDICAD APPLICATION IN PROGRESS