Provider Demographics
NPI:1790272664
Name:CONRAD, CARRIE (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 PLEASANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9494
Mailing Address - Country:US
Mailing Address - Phone:800-779-4089
Mailing Address - Fax:
Practice Address - Street 1:2848 PLEASANT ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-2970
Practice Address - Country:US
Practice Address - Phone:800-779-4089
Practice Address - Fax:803-547-9706
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist