Provider Demographics
NPI:1518207281
Name:LYDON, CAROL M (AUD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:LYDON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:KIBBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-472-1300
Mailing Address - Fax:336-472-1302
Practice Address - Street 1:1213 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3416
Practice Address - Country:US
Practice Address - Phone:336-472-1300
Practice Address - Fax:336-472-1302
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist