Provider Demographics
NPI:1093424863
Name:FRIEND, CAROLYN J (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:J
Last Name:FRIEND
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 1:371 S 900 W
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-8795
Mailing Address - Country:US
Mailing Address - Phone:765-860-4096
Mailing Address - Fax:
Practice Address - Street 1:371 S 900 W
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-8795
Practice Address - Country:US
Practice Address - Phone:765-860-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
IN01066339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCFRIE008Medicaid