Provider Demographics
NPI:1174782544
Name:SOUTHARD, CAROL ANNETTE (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNETTE
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 OLD CLEAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-7962
Mailing Address - Country:US
Mailing Address - Phone:606-305-1355
Mailing Address - Fax:
Practice Address - Street 1:1841 OLD CLEAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-7962
Practice Address - Country:US
Practice Address - Phone:606-305-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1381235Z00000X
KY140856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist