Provider Demographics
NPI:1033562541
Name:MAIZE, CARLA R (MS)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:R
Last Name:MAIZE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TAYLORSVILLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:PA
Mailing Address - Zip Code:17964-9104
Mailing Address - Country:US
Mailing Address - Phone:570-644-0489
Mailing Address - Fax:
Practice Address - Street 1:200 TAYLORSVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:PA
Practice Address - Zip Code:17964-9104
Practice Address - Country:US
Practice Address - Phone:570-644-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005491L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist