Healthcare Provider Details

I. General information

NPI: 1578470357
Provider Name (Legal Business Name): CARLY WEBERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 MANDALAY AVE
ROYAL OAK MI
48073-1622
US

IV. Provider business mailing address

26012 DUNDEE RD
HUNTINGTON WOODS MI
48070-1309
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-4968
  • Fax:
Mailing address:
  • Phone: 248-763-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: