Provider Demographics
NPI:1538456009
Name:SULLENBARGER, CARAH JANE (SLPD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:CARAH
Middle Name:JANE
Last Name:SULLENBARGER
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9919 TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8260
Mailing Address - Country:US
Mailing Address - Phone:317-872-4166
Mailing Address - Fax:317-872-3234
Practice Address - Street 1:9919 TOWNE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8260
Practice Address - Country:US
Practice Address - Phone:317-872-4166
Practice Address - Fax:317-872-3234
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105795235Z00000X
IN22005484A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300060257Medicaid