Provider Demographics
NPI:1114531068
Name:FORD, CAROL ANNE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:FORD
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6904
Mailing Address - Country:US
Mailing Address - Phone:704-443-7033
Mailing Address - Fax:
Practice Address - Street 1:3075 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6904
Practice Address - Country:US
Practice Address - Phone:704-443-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14330231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist