Active NPI
Karen Detlefsen Price, MA CCC/SLP
- Speech-Language Pathologist
- Loganville, GA
National Provider Identifier
1497748586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP004265
- Practice address
- 200 Ivy Creek Dr
Loganville, GA 30052-3119 - Phone
- (404) 883-6913
- Fax
- (770) 554-0156
- NPI assigned
- Aug 24, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP004265 | GA | Primary |
Addresses
Primary practice location
200 Ivy Creek Dr
Loganville, GA 30052-3119
Mailing address
200 Ivy Creek Dr
Loganville, GA 30052-3119
Phone (404) 883-6913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000785793B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP004265 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666742400000",
"number": "1497748586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 IVY CREEK DR",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300523119",
"telephone_number": "404-883-6913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 IVY CREEK DR",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300523119",
"telephone_number": "404-883-6913",
"fax_number": "770-554-0156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRICE",
"first_name": "KAREN",
"middle_name": "DETLEFSEN",
"credential": "MA CCC/SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-24",
"last_updated": "2022-10-26",
"certification_date": "2022-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP004265",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000785793B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loganville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.