Provider Demographics
NPI:1689712150
Name:KANTOR, CARRIE VANESSA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:VANESSA
Last Name:KANTOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5301
Mailing Address - Country:US
Mailing Address - Phone:516-867-2164
Mailing Address - Fax:
Practice Address - Street 1:2983 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5301
Practice Address - Country:US
Practice Address - Phone:516-867-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007459-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist