Provider Demographics
NPI:1417042441
Name:DEAN, CAROLEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLEE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 HAMPTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2675
Mailing Address - Country:US
Mailing Address - Phone:505-323-9272
Mailing Address - Fax:
Practice Address - Street 1:8509 HAMPTON AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2675
Practice Address - Country:US
Practice Address - Phone:505-323-9272
Practice Address - Fax:505-875-0801
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10026761OtherLOVELACE HEALTH PLAN
NMQMYPR0072410OtherMOLINA HEALTHCARE
NM12950271Medicaid