Provider Demographics
NPI:1942586714
Name:GIBSON, CAROLYN BALL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:BALL
Last Name:GIBSON
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 1:1 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-1406
Mailing Address - Country:US
Mailing Address - Phone:315-353-2156
Mailing Address - Fax:
Practice Address - Street 1:1 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NY
Practice Address - Zip Code:13668-1406
Practice Address - Country:US
Practice Address - Phone:315-353-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017986-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist