Provider Demographics
NPI:1083037253
Name:DZAMBIK, CAROL M (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:M
Last Name:DZAMBIK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1966
Mailing Address - Country:US
Mailing Address - Phone:440-985-1646
Mailing Address - Fax:
Practice Address - Street 1:2140 E 36TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2756
Practice Address - Country:US
Practice Address - Phone:440-277-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist