Provider Demographics
NPI:1710139910
Name:CHEN, CARRIE L (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:CHEN
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 1:1156 LEVELS ROAD
Mailing Address - Street 2:MOT CHARTER SCHOOL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709
Mailing Address - Country:US
Mailing Address - Phone:302-376-5125
Mailing Address - Fax:302-376-5120
Practice Address - Street 1:1156 LEVELS RD
Practice Address - Street 2:MOT CHARTER SCHOOL
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9078
Practice Address - Country:US
Practice Address - Phone:302-376-5125
Practice Address - Fax:302-376-5120
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0000748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist