Provider Demographics
NPI:1497105746
Name:MILDNER, CAROLINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:
Last Name:MILDNER
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 1:54 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2318
Mailing Address - Country:US
Mailing Address - Phone:914-815-0682
Mailing Address - Fax:
Practice Address - Street 1:54 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2318
Practice Address - Country:US
Practice Address - Phone:914-815-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist