Healthcare Provider Details

I. General information

NPI: 1194405712
Provider Name (Legal Business Name): CARLY PAIGE ENSLEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 ABUTMENT RD
DALTON GA
30721-4680
US

IV. Provider business mailing address

134 BELFAST LN
ROCKY FACE GA
30740-9624
US

V. Phone/Fax

Practice location:
  • Phone: 706-252-8660
  • Fax:
Mailing address:
  • Phone: 706-483-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP012665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: