Healthcare Provider Details

I. General information

NPI: 1548484785
Provider Name (Legal Business Name): CAROLINE WATHEN M.ED, CF,SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE LEA STREPPA

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CLIFTON RD NE
ATLANTA GA
30322-1004
US

IV. Provider business mailing address

925 CANTERBURY RD NE 926
ATLANTA GA
30324-6017
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5512
  • Fax: 404-712-5974
Mailing address:
  • Phone: 678-438-6855
  • Fax: 404-712-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET001186
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3968
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: