Provider Demographics
NPI:1659083921
Name:CRAIG, CAROLINE HUDGENS (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HUDGENS
Last Name:CRAIG
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 1:3912 S WADSWORTH BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2265
Mailing Address - Country:US
Mailing Address - Phone:804-869-7472
Mailing Address - Fax:
Practice Address - Street 1:3912 S WADSWORTH BLVD APT 107
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2265
Practice Address - Country:US
Practice Address - Phone:804-869-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0005806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist