Provider Demographics
NPI:1598886319
Name:REEVES, CAROLLYN SUE (BC-HIS)
Entity Type:Individual
Prefix:MS
First Name:CAROLLYN
Middle Name:SUE
Last Name:REEVES
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1453
Mailing Address - Country:US
Mailing Address - Phone:606-528-1136
Mailing Address - Fax:606-528-4758
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1453
Practice Address - Country:US
Practice Address - Phone:606-528-1136
Practice Address - Fax:606-528-4758
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0218237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist