Provider Demographics
NPI:1164570214
Name:MCCREADY, CAROLYN VICK (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:VICK
Last Name:MCCREADY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:MCCREADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:HIGHLAND AVENUE 300 FERGUSON BUILDING
Mailing Address - Street 2:UNIVERSITY OF NC AT GREENSBORO
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-6170
Mailing Address - Country:US
Mailing Address - Phone:336-334-5939
Mailing Address - Fax:336-334-4475
Practice Address - Street 1:300 FERGUSON BUILDING
Practice Address - Street 2:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-6170
Practice Address - Country:US
Practice Address - Phone:336-334-5939
Practice Address - Fax:336-334-4475
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist