Provider Demographics
NPI:1558517698
Name:LANDIS, CARRIE ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:LANDIS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:CHRIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:175 PARAMOUNT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1065
Mailing Address - Country:US
Mailing Address - Phone:508-910-2221
Mailing Address - Fax:508-910-2214
Practice Address - Street 1:51 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-910-2221
Practice Address - Fax:508-910-2214
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA757231H00000X
RIAUD00187231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007061097Medicare PIN