Provider Demographics
NPI:1861048118
Name:BREEDING, CAROLINE BOYD (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BOYD
Last Name:BREEDING
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 1:4536 S CREST OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3825
Mailing Address - Country:US
Mailing Address - Phone:801-915-7342
Mailing Address - Fax:
Practice Address - Street 1:6965 SAN LUIS AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5201
Practice Address - Country:US
Practice Address - Phone:805-591-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14285661OtherAMERICAN SPEECH AND HEARING ASSOCIATION (ASHA)
CA30663OtherCALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS /SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY