Provider Demographics
NPI:1003124892
Name:MCPHERSON, CAROLYN MARIE (MA, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-0231
Mailing Address - Country:US
Mailing Address - Phone:315-386-4504
Mailing Address - Fax:
Practice Address - Street 1:139 STATE STREET RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3504
Practice Address - Country:US
Practice Address - Phone:315-386-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006399-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist