Provider Demographics
NPI:1982223020
Name:NACKE, CAROL (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:NACKE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SCIONEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 CLAYTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2055
Mailing Address - Country:US
Mailing Address - Phone:314-504-8748
Mailing Address - Fax:
Practice Address - Street 1:235 CLAYTON OAKS DR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2055
Practice Address - Country:US
Practice Address - Phone:314-504-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist