Provider Demographics
NPI:1538562780
Name:BOALS, CAROL (SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:BOALS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:MARTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1070 HANLEY RD W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1520
Mailing Address - Country:US
Mailing Address - Phone:419-571-1493
Mailing Address - Fax:
Practice Address - Street 1:1070 HANLEY RD W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-1520
Practice Address - Country:US
Practice Address - Phone:419-571-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist