Healthcare Provider Details

I. General information

NPI: 1548192842
Provider Name (Legal Business Name): JACQUELYN CARNEY CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELYN ANN CARR SLP

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 E BONNYVIEW RD
REDDING CA
96001-4535
US

IV. Provider business mailing address

2727 SNOW LN
REDDING CA
96003-3414
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-0011
  • Fax: 530-225-2249
Mailing address:
  • Phone: 530-225-0011
  • Fax: 530-225-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP6725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: