Provider Demographics
NPI:1326691031
Name:CARR, AUDREY HOLLY (SLP-ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:HOLLY
Last Name:CARR
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2423
Mailing Address - Country:US
Mailing Address - Phone:321-338-2419
Mailing Address - Fax:321-301-4278
Practice Address - Street 1:1237 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2423
Practice Address - Country:US
Practice Address - Phone:321-338-2419
Practice Address - Fax:321-301-4278
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant