Provider Demographics
NPI:1023141173
Name:CARSON, CECYLE KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:CECYLE
Middle Name:KAY
Last Name:CARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14857 OLDHAM DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4115
Mailing Address - Country:US
Mailing Address - Phone:321-235-2825
Mailing Address - Fax:
Practice Address - Street 1:14857 OLDHAM DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4115
Practice Address - Country:US
Practice Address - Phone:321-235-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist