Provider Demographics
NPI:1366994030
Name:WASYLCZUK, KARA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:WASYLCZUK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 KILLARY CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4162
Mailing Address - Country:US
Mailing Address - Phone:614-296-3419
Mailing Address - Fax:
Practice Address - Street 1:5620 DUBLINSHIRE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2420
Practice Address - Country:US
Practice Address - Phone:614-761-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist