Provider Demographics
NPI:1508199746
Name:SHRIVER, CARLA J (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:SHRIVER
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 1:2031 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5070
Mailing Address - Country:US
Mailing Address - Phone:307-237-4477
Mailing Address - Fax:307-237-6672
Practice Address - Street 1:800 WERNER CT STE 150
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1359
Practice Address - Country:US
Practice Address - Phone:307-237-4477
Practice Address - Fax:307-237-6672
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist