Provider Demographics
NPI:1518246651
Name:PAINTER, CAROLINE JEAN (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JEAN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-0379
Mailing Address - Country:US
Mailing Address - Phone:716-244-0038
Mailing Address - Fax:
Practice Address - Street 1:1 KING ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:NY
Practice Address - Zip Code:14711-8682
Practice Address - Country:US
Practice Address - Phone:585-365-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021275-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist