Provider Demographics
NPI:1013046762
Name:NIEDERER, CAROL (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:NIEDERER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S KILLINGLY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1351
Mailing Address - Country:US
Mailing Address - Phone:401-678-0972
Mailing Address - Fax:
Practice Address - Street 1:105 S KILLINGLY RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1351
Practice Address - Country:US
Practice Address - Phone:401-678-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412422OtherBCBS, PRIVATE PRACTICE
RI29180-8OtherBCBSRI DBA GRODEN CTR
RI31485-5OtherBCBSRI , PRIVATE PRACTICE