Provider Demographics
NPI:1154674737
Name:SHAY, CARMA GRACE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMA
Middle Name:GRACE
Last Name:SHAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37397 CETACEA LN
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8778
Mailing Address - Country:US
Mailing Address - Phone:907-978-5531
Mailing Address - Fax:
Practice Address - Street 1:37397 CETACEA LN
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8778
Practice Address - Country:US
Practice Address - Phone:907-978-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist