Provider Demographics
NPI:1003981036
Name:LUDWIG, CAROL SUE (PHD CCC SP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:SUE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:PHD CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 COUNTY ROAD 436
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1821
Mailing Address - Country:US
Mailing Address - Phone:573-243-5427
Mailing Address - Fax:
Practice Address - Street 1:215 WEST MAIN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755
Practice Address - Country:US
Practice Address - Phone:573-204-0490
Practice Address - Fax:573-204-0009
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist