MEDICARE: TONYA PETERS CARR 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
1	235Z00000X	Speech-Language Pathologist	22003161A	IN

General Provider Information

NPI Number	:	1770799504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA PETERS CARR SLP

Provider Business Mailing Address
First Line	:	8110 STONEREATH CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9276
Country	:	US
Telephone Number	:	317-313-8456
Fax Number	:

Provider Business Practice Location Address
First Line	:	7855 S EMERSON AVE STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8669
Country	:	US
Telephone Number	:	317-313-8456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	11/01/2016

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