Provider Demographics
NPI:1811422827
Name:TEWANGER, CARLEY
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:TEWANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SWEETAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5005
Mailing Address - Country:US
Mailing Address - Phone:740-989-2000
Mailing Address - Fax:
Practice Address - Street 1:95 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:LITTLE HOCKING
Practice Address - State:OH
Practice Address - Zip Code:45742-5001
Practice Address - Country:US
Practice Address - Phone:740-989-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist