Provider Demographics
NPI:1710459870
Name:PROUDFIT, CAROL ANNE SMITH
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE SMITH
Last Name:PROUDFIT
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 1:397 MILAN HWY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38316-9707
Mailing Address - Country:US
Mailing Address - Phone:731-414-5520
Mailing Address - Fax:
Practice Address - Street 1:2036 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2941
Practice Address - Country:US
Practice Address - Phone:731-855-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist