Provider Demographics
NPI:1356639306
Name:FIERRO, CAROLYN HAMMACK (M S CCC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:HAMMACK
Last Name:FIERRO
Suffix:
Gender:F
Credentials:M S CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6087 JAMESON CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6305
Mailing Address - Country:US
Mailing Address - Phone:850-995-9092
Mailing Address - Fax:
Practice Address - Street 1:6087 JAMESON CIR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6305
Practice Address - Country:US
Practice Address - Phone:850-995-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist