Provider Demographics
NPI:1922663293
Name:MCCAULEY, CARISSA RICHELLE (AUD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:RICHELLE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 TENNIS WAY
Mailing Address - Street 2:
Mailing Address - City:EAST DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05253-4410
Mailing Address - Country:US
Mailing Address - Phone:802-362-4865
Mailing Address - Fax:802-366-8277
Practice Address - Street 1:51 TENNIS WAY
Practice Address - Street 2:
Practice Address - City:EAST DORSET
Practice Address - State:VT
Practice Address - Zip Code:05253-4410
Practice Address - Country:US
Practice Address - Phone:802-362-4865
Practice Address - Fax:802-366-8277
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist