Provider Demographics
NPI:1467144105
Name:CARPER, LYNN ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:CARPER
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 1:1611 INVERNESS RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA
Mailing Address - State:FL
Mailing Address - Zip Code:32034-7930
Mailing Address - Country:US
Mailing Address - Phone:904-553-7391
Mailing Address - Fax:
Practice Address - Street 1:1611 INVERNESS RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-7930
Practice Address - Country:US
Practice Address - Phone:904-553-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist