Provider Demographics
NPI:1992865430
Name:FREE, CAROL KATHLEEN (MS)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:KATHLEEN
Last Name:FREE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:412 BRODHEAD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1604
Mailing Address - Country:US
Mailing Address - Phone:610-253-1144
Mailing Address - Fax:610-253-9009
Practice Address - Street 1:245 M MT HERMON ROAD
Practice Address - Street 2:SUITE 149
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4045
Practice Address - Country:US
Practice Address - Phone:831-336-4444
Practice Address - Fax:831-604-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU635231H00000X
PAAT000270L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0006350Medicaid
CAZZZ23902ZMedicare PIN
PA076678Medicare PIN