Healthcare Provider Details

I. General information

NPI: 1346909835
Provider Name (Legal Business Name): CAROLINE NIEMEIER CCC-SLP, CBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 GRIMES BRIDGE RD
ROSWELL GA
30075-3991
US

IV. Provider business mailing address

1160 GRIMES BRIDGE RD STE B
ROSWELL GA
30075-3900
US

V. Phone/Fax

Practice location:
  • Phone: 470-423-9477
  • Fax:
Mailing address:
  • Phone: 404-625-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: