Provider Demographics
NPI:1801176904
Name:BECKER, CAROL (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 GREAT LAKES DR S
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5251
Mailing Address - Country:US
Mailing Address - Phone:863-214-6553
Mailing Address - Fax:
Practice Address - Street 1:4491 GREAT LAKES DR S
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-5251
Practice Address - Country:US
Practice Address - Phone:863-214-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist