Provider Demographics
NPI:1669670709
Name:QUAMEN, CARRIE M (MA-CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:QUAMEN
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-2245
Mailing Address - Country:US
Mailing Address - Phone:605-366-8613
Mailing Address - Fax:
Practice Address - Street 1:1030 N JAMES AVE
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-2245
Practice Address - Country:US
Practice Address - Phone:605-366-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01412235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist