Provider Demographics
NPI:1700395217
Name:STIER, CAROLYN SUE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:STIER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAKESIDE PL N
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4388
Mailing Address - Country:US
Mailing Address - Phone:262-729-7647
Mailing Address - Fax:
Practice Address - Street 1:5 LAKESIDE PL N
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-4388
Practice Address - Country:US
Practice Address - Phone:262-729-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist