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General NPI Number Information
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NPI Number | 1326659137
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Entity Type | Individual
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Provider Name | CAROLYN MARIE BUISSON M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 4400 N UNION RD
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City | TROTWOOD
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State | OH
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Zip | 45426-3706
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Country | US
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Telephone | 937-854-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 HARBURY DR
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City | CINCINNATI
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State | OH
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Zip | 45224-2208
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Country | US
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Telephone | 513-257-4348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.14087
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License Number State | OH
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