Provider Demographics
NPI:1407902232
Name:EASTHAM, CAROLYN ANN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:OWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:803 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3242
Mailing Address - Country:US
Mailing Address - Phone:630-513-6560
Mailing Address - Fax:
Practice Address - Street 1:40W310 LAFOX RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6588
Practice Address - Country:US
Practice Address - Phone:630-444-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist