Provider Demographics
NPI:1801836416
Name:BROSWSKI, CAROLYN A (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:BROSWSKI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000-109 BRENTMOOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604
Mailing Address - Country:US
Mailing Address - Phone:919-227-2324
Mailing Address - Fax:
Practice Address - Street 1:48 KYLE DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7535
Practice Address - Country:US
Practice Address - Phone:919-359-1323
Practice Address - Fax:919-359-8992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1074XOtherBCBSNC
NC7411356Medicaid