Provider Demographics
NPI:1790908333
Name:PERRY, CARMEN LYNETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LYNETTE
Last Name:PERRY
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 1:42 E EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1123
Mailing Address - Country:US
Mailing Address - Phone:716-946-2269
Mailing Address - Fax:
Practice Address - Street 1:42 E EVANS ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-1123
Practice Address - Country:US
Practice Address - Phone:716-946-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033937-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist