Provider Demographics
NPI:1346517265
Name:FREE, CHARLENE (MACCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:FREE
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 TURNBERRY DR APT A
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-6842
Mailing Address - Country:US
Mailing Address - Phone:614-302-3354
Mailing Address - Fax:
Practice Address - Street 1:400 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2024
Practice Address - Country:US
Practice Address - Phone:740-376-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHST615202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist