Provider Demographics
NPI:1548484785
Name:WATHEN, CAROLINE (MED, CF,SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:WATHEN
Suffix:
Gender:
Credentials:MED, CF,SLP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:LEA
Other - Last Name:STREPPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:925 CANTERBURY RD NE
Mailing Address - Street 2:926
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6017
Mailing Address - Country:US
Mailing Address - Phone:678-438-6855
Mailing Address - Fax:404-712-5974
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-712-5512
Practice Address - Fax:404-712-5974
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001186235Z00000X
AL3968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist