MEDICARE: MRS. CONNIE GRAY CARLTON M.A.ED.,M.S.,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5058	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127AW	OTHER	NC	NCBCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780687764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE GRAY CARLTON M.A.ED.,M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	208 PLEASANT HILL RD
Second Line	:
City	:	TRENTON
State	:	NC
Zip	:	28585-6381
Country	:	US
Telephone Number	:	252-448-9841
Fax Number	:	252-448-1773

Provider Business Practice Location Address
First Line	:	208 PLEASANT HILL RD
Second Line	:
City	:	TRENTON
State	:	NC
Zip	:	28585-6381
Country	:	US
Telephone Number	:	252-448-9841
Fax Number	:	252-448-1773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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