Provider Demographics
NPI:1336321694
Name:HAYDEN, CAROL AYCOCK (MS,/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:AYCOCK
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MS,/CCC/SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:AYCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 E BIDWELL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3452
Mailing Address - Country:US
Mailing Address - Phone:916-983-5925
Mailing Address - Fax:
Practice Address - Street 1:3280 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5838
Practice Address - Country:US
Practice Address - Phone:530-622-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X235Z00000X
CASP 14233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist