Provider Demographics
NPI:1609138114
Name:PEARCE, CAROLYN MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2701 E JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6258
Mailing Address - Country:US
Mailing Address - Phone:714-602-9717
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 137
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-901-1518
Practice Address - Fax:714-901-1359
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist