Provider Demographics
NPI:1114246162
Name:NEAL, CARRIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 CITY LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2657
Mailing Address - Country:US
Mailing Address - Phone:949-581-8239
Mailing Address - Fax:949-859-0849
Practice Address - Street 1:23361 MADERO
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2715
Practice Address - Country:US
Practice Address - Phone:949-581-8239
Practice Address - Fax:949-859-0849
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist