Provider Demographics
NPI:1043473549
Name:CARLOCK, JOY E (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:E
Last Name:CARLOCK
Suffix:
Gender:F
Credentials: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 1:120 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5226
Mailing Address - Country:US
Mailing Address - Phone:845-633-2123
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GARDINER
Practice Address - State:NY
Practice Address - Zip Code:12525-5226
Practice Address - Country:US
Practice Address - Phone:845-633-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist