Provider Demographics
NPI:1902070113
Name:SHAW, CAROL (MSCCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRIDPORT PL
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-4633
Mailing Address - Country:US
Mailing Address - Phone:732-657-1330
Mailing Address - Fax:732-657-0224
Practice Address - Street 1:1166 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5600
Practice Address - Country:US
Practice Address - Phone:908-783-8481
Practice Address - Fax:732-657-0224
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00032200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist