Provider Demographics
NPI:1154507853
Name:FREDERICK-FARMER, CARMIN ALANA (MHS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CARMIN
Middle Name:ALANA
Last Name:FREDERICK-FARMER
Suffix:
Gender:F
Credentials:MHS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-3726
Mailing Address - Country:US
Mailing Address - Phone:773-330-4717
Mailing Address - Fax:773-442-0225
Practice Address - Street 1:40 N MASON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-3726
Practice Address - Country:US
Practice Address - Phone:773-330-4717
Practice Address - Fax:773-442-0225
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist