Provider Demographics
NPI:1326766528
Name:RANUM, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:RANUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 BRIARMONT AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4214
Mailing Address - Country:US
Mailing Address - Phone:608-577-0984
Mailing Address - Fax:
Practice Address - Street 1:2715 STATE ROAD AA
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1241
Practice Address - Country:US
Practice Address - Phone:573-896-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022019677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist