Provider Demographics
NPI:1437517398
Name:AYRES, CARA LEE ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARA LEE
Middle Name:ANN
Last Name:AYRES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MISTY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366
Mailing Address - Country:US
Mailing Address - Phone:636-293-1169
Mailing Address - Fax:
Practice Address - Street 1:18 MISTY BROOK CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4920
Practice Address - Country:US
Practice Address - Phone:636-293-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist