Provider Demographics
NPI:1689215428
Name:VOWLES, CARLY GRACE
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:GRACE
Last Name:VOWLES
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 1:261 INDIAN RUN ST UNIT 4212
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-3719
Mailing Address - Country:US
Mailing Address - Phone:410-487-1297
Mailing Address - Fax:
Practice Address - Street 1:1695 LENAPE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-6801
Practice Address - Country:US
Practice Address - Phone:610-793-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000411390200000X
PASL016916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program