Provider Demographics
NPI:1013225861
Name:ADAMS-CARR, JACQUELYNN (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYNN
Middle Name:
Last Name:ADAMS-CARR
Suffix:
Gender:F
Credentials: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:P.O. BOX 94164
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35220-4164
Mailing Address - Country:US
Mailing Address - Phone:205-253-0098
Mailing Address - Fax:205-854-1953
Practice Address - Street 1:530 BEACON PARKWAY WEST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-253-0098
Practice Address - Fax:205-854-1953
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009904710Medicaid