Provider Demographics
NPI:1053634253
Name:SERCER, CAROLINE (MA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SERCER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 SHANNON WILLOW RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1353
Mailing Address - Country:US
Mailing Address - Phone:704-540-3777
Mailing Address - Fax:
Practice Address - Street 1:6911 SHANNON WILLOW RD STE 700
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1353
Practice Address - Country:US
Practice Address - Phone:704-540-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC8608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist