Provider Demographics
NPI:1801097175
Name:HEATH, CARIE LYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:LYN
Last Name:HEATH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 PEQUAWKET TRAIL
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04010-4905
Mailing Address - Country:US
Mailing Address - Phone:207-542-5598
Mailing Address - Fax:
Practice Address - Street 1:1298 PEQUAWKET TRAIL
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:ME
Practice Address - Zip Code:04010-4905
Practice Address - Country:US
Practice Address - Phone:207-542-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist