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NPI Code Detail

MEDICARE: CAROLYN DOETZER M.A. CCC/SLP

MEDICARE:   CAROLYN  DOETZER  M.A. CCC/SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2942TN

General Provider Information

NPI Number : 1649635145
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN DOETZER M.A. CCC/SLP
Provider Business Mailing Address
First Line : 1600 KENDALE CT
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-3529
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 529 MIDWAY CIR
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-5178
Country : US
Telephone Number : 615-578-4339
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2015
Last Update Date : 12/28/2015

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Directions to “ CAROLYN DOETZER M.A. CCC/SLP” Practice Location

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