Provider Demographics
NPI:1154446136
Name:MACAUDA, CARRIE LYNN (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:MACAUDA
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 EMERALD LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7444
Mailing Address - Country:US
Mailing Address - Phone:330-414-2848
Mailing Address - Fax:
Practice Address - Street 1:155 HERITAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1398
Practice Address - Country:US
Practice Address - Phone:330-666-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist