Provider Demographics
NPI:1790916062
Name:CARTER, KELLIE DEMPSEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:DEMPSEY
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CAROLINA CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GRANDY
Mailing Address - State:NC
Mailing Address - Zip Code:27939-9633
Mailing Address - Country:US
Mailing Address - Phone:757-617-8062
Mailing Address - Fax:
Practice Address - Street 1:145 CAROLINA CLUB DR
Practice Address - Street 2:
Practice Address - City:GRANDY
Practice Address - State:NC
Practice Address - Zip Code:27939-9633
Practice Address - Country:US
Practice Address - Phone:252-453-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist