Provider Demographics
NPI:1245422831
Name:BASTIN, CAROL ELAINE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELAINE
Last Name:BASTIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ELAINE
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:4 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2429
Mailing Address - Country:US
Mailing Address - Phone:937-436-2273
Mailing Address - Fax:937-433-1842
Practice Address - Street 1:3800 SUMMIT GLEN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3647
Practice Address - Country:US
Practice Address - Phone:937-436-2273
Practice Address - Fax:937-433-1842
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4126-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist