Provider Demographics
NPI:1629676994
Name:IWANKOVITSCH-ROSS, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:IWANKOVITSCH-ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9554
Mailing Address - Country:US
Mailing Address - Phone:802-751-7431
Mailing Address - Fax:
Practice Address - Street 1:45 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:VT
Practice Address - Zip Code:05819-9554
Practice Address - Country:US
Practice Address - Phone:802-751-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist