Provider Demographics
NPI:1861947103
Name:SAUNDERS, CARLY (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:1390 N POPLAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-7112
Mailing Address - Country:US
Mailing Address - Phone:304-757-7856
Mailing Address - Fax:606-329-9143
Practice Address - Street 1:1390 N POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-7112
Practice Address - Country:US
Practice Address - Phone:304-757-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168907235Z00000X
WV2075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty