Provider Demographics
NPI:1760161475
Name:POTTER, CAROLINE (AUD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WOODBINE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1774
Mailing Address - Country:US
Mailing Address - Phone:812-230-5112
Mailing Address - Fax:
Practice Address - Street 1:5080 E BILL FARR DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9324
Practice Address - Country:US
Practice Address - Phone:812-230-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist