Provider Demographics
NPI:1548360381
Name:KAJIWARA-NELSON, KAREN EMI (MS)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:EMI
Last Name:KAJIWARA-NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:EMI
Other - Last Name:KAJIWARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:107 H ST. E
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:
Practice Address - Street 1:107 H ST. EAST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT775231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210068Medicaid
MT775OtherDEPT OF L & I
MT2210068Medicaid