Provider Demographics
NPI:1558936864
Name:LAMBERT, CARLIE COLLEEN (SLP)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:COLLEEN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-3344
Mailing Address - Country:US
Mailing Address - Phone:601-795-2043
Mailing Address - Fax:601-795-2025
Practice Address - Street 1:9 BALMORAL DR
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3344
Practice Address - Country:US
Practice Address - Phone:601-795-2043
Practice Address - Fax:601-795-2025
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS4792OtherLICENSURE