Provider Demographics
NPI:1013422674
Name:RAE, CAROLINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RAE
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 1:3100 CARNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405
Mailing Address - Country:US
Mailing Address - Phone:619-246-5914
Mailing Address - Fax:
Practice Address - Street 1:3100 CARNER AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:619-246-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist