Provider Demographics
NPI:1013196435
Name:DOLEYS, CAREN MALIN (MED, MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:MALIN
Last Name:DOLEYS
Suffix:
Gender:F
Credentials:MED, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 REGIMENT DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8462
Mailing Address - Country:US
Mailing Address - Phone:678-557-9581
Mailing Address - Fax:678-574-6695
Practice Address - Street 1:1120 REGIMENT DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8462
Practice Address - Country:US
Practice Address - Phone:678-557-9581
Practice Address - Fax:678-574-6695
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA289142893AMedicaid
1013196435OtherANTHEM BLUE CROSS BLUE SHIELD OF GEORGIA