Healthcare Provider Details

I. General information

NPI: 1336321694
Provider Name (Legal Business Name): CAROL AYCOCK HAYDEN M.S,/CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL AYCOCK

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 WASHINGTON ST
PLACERVILLE CA
95667-5838
US

IV. Provider business mailing address

1301 E BIDWELL ST SUITE 201
FOLSOM CA
95630-3452
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-6842
  • Fax:
Mailing address:
  • Phone: 916-983-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number235Z00000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 14233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: