Provider Demographics
NPI:1528215852
Name:BEQUETTE, CAROLYN A (AUD)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:BEQUETTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-453-0561
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, STE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6859
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-453-0489
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019042231H00000X
MO2001017967237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO330045418Medicaid