Healthcare Provider Details

I. General information

NPI: 1780936609
Provider Name (Legal Business Name): CAITLYN DIANE CAREY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4907 NW 43RD ST SUITE C
GAINESVILLE FL
32606-2006
US

IV. Provider business mailing address

8516 SW 92ND LN
GAINESVILLE FL
32608-7271
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: