Provider Demographics
NPI:1932306974
Name:KOLEDA, CAROLYN M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:KOLEDA
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 1:46322 HOUGHTON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5328
Mailing Address - Country:US
Mailing Address - Phone:586-726-7568
Mailing Address - Fax:
Practice Address - Street 1:27450 SCHOENHERR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6683
Practice Address - Country:US
Practice Address - Phone:586-582-7825
Practice Address - Fax:586-582-7826
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5171931Medicaid
MI230195Medicare ID - Type Unspecified