Provider Demographics
NPI:1346548021
Name:POWERS, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:POWERS
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 1:160 MEDBURY RD
Mailing Address - Street 2:
Mailing Address - City:PORTER CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12859-1908
Mailing Address - Country:US
Mailing Address - Phone:518-893-2801
Mailing Address - Fax:
Practice Address - Street 1:160 MEDBURY RD
Practice Address - Street 2:
Practice Address - City:PORTER CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12859-1908
Practice Address - Country:US
Practice Address - Phone:518-893-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01525-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist