Provider Demographics
NPI:1619316437
Name:SHOWALTER, CAROLYN MICHELLE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELLE
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MICHELLE
Other - Last Name:HACKSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:913 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7853
Mailing Address - Country:US
Mailing Address - Phone:402-932-0747
Mailing Address - Fax:402-991-5685
Practice Address - Street 1:913 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7853
Practice Address - Country:US
Practice Address - Phone:402-932-0747
Practice Address - Fax:402-991-5685
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist