Provider Demographics
NPI:1659700821
Name:FORDE, CARRIE (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:FORDE
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 BROOKS CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5487
Mailing Address - Country:US
Mailing Address - Phone:404-933-9316
Mailing Address - Fax:
Practice Address - Street 1:759 BROOKS CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5487
Practice Address - Country:US
Practice Address - Phone:404-933-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001877235Z00000X
GASLP008441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist